Académique Documents
Professionnel Documents
Culture Documents
2015
TABLE OF CONTENTS
INTRODUCTION
CONTACT INFORMATION
6-7
10
11
12
13
STUDENT RESOURCES
14
18
19
23
33
43
65
77
88
98
112
120
131
132
135
136
149
154
166
171
July 2015
INTRODUCTION
Welcome to the clinical year of your PA training. This is a very exciting time for each of you
as you will be working full-time with preceptors in a variety of discipline, work on
individualized research projects and attend grand rounds, seminars, and other learning
venues during clinical rotations.
Your core rotations are directed toward the student developing clinical competence and
confidence in a variety of domains: knowledge, procedure/skills, clinical problem-solving,
cultural intelligence, patient safety and quality assurance, social determinants of health, and
professional attitudes and behaviors in the diagnosis and management of fundamental
medical problems associated with the particular medical discipline.
All clinical preceptors and/or their PA designee serve as volunteers of their time and talents
to participate in the medical model of learning in the clinical setting. All preceptors and
clinical site rotations have been vetted by the USA PA program and selected based on a
number of criteria including, but not limited to, expertise, enthusiasm for teaching,
willingness to teach and student safety. Combined with your enthusiasm, thirst for clinical
and social knowledge, and dedication to interprofessional collaborative patient-centered
care, the 2014-2015 clinical year will be a major success.
This revised Clinical Manual offers general guidelines and details regarding the clinical
education experience for physician assistant students. This manual serves only as a guide.
You are encouraged and expected to become familiar with all the information contained
within this manual. If you should experience any problems or have further questions, please
contact the Department of Physician Assistant Studies Clinical Assistant Ms. Natasha
Edwards at 251-460-7596, nedwards@southalabama.edu; Dr. D. Abercrombie, Program
Director at 251-445-9334, dabercrombie@southalabama.edu.
Please contact the Program Director regarding issues not addressed in this manual.
Students are responsible for maintaining close communication with the Director of Clinical
Education and the Program Director throughout the clinical phase. Checking your USA
jagmail account DAILY is required! We will use this method to communicate important
deadlines, changes to assignments and updates that occur on a regular basis.
Strive not to be a success, but rather to be of value. Albert Einstein
Health and Happiness,
Diane D. Abercrombie, PA-C, Ph.D.
Program Director & Chair
Office: (251) 445-9334
Fax: (251) 445-9336
dabercrombie@southalabama.edu
July 2015
CONTACT INFORMATION
Department Chair:
Natasha Edwards
nedwards@southalabama.edu
Office:
(251) 460-7596
Fax:
(251) 445-9336
Cheryl Nicholls, BA
cherylnicholls@southalabama.edu
Office:
(251) 445-9520
Fax:
(251) 445-9336
Admissions Coordinator:
Nancy Dunn, BA
ndunn@southalabama.edu
Office:
(251) 445-9345
Fax:
(251) 445-9336
Departmental Secretary:
Ginny Harris
gharris@southalabama.edu
Office:
(251) 445-9345
Fax:
(251) 445-9336
Program Office:
July 2015
Vision
The Physician Assistant Studies program curriculum is closely related to the goals of the University of
South Alabama as well as to the degree. The program fosters an environment that promotes the
acquisition and application of culturally sensitive, patient-oriented clinical knowledge and skills to
produce a diverse workforce of primary care physician assistants who practice medicine with
competence, professionalism, and compassion driven by academic excellence and a spirit of service
to the community.
Goals
1. Emphasize primary care and a desire among physician assistants toward service in rural and
medically underserved communities;
2. Promote excellence in healthcare by preparing competent physician assistants to practice
evidence-based medicine in all clinical settings;
3. Ensure opportunities for placement of qualified military veterans through participation as a
PAEA Member Program offering assistance for veteran entry into physician assistant
programs;
4. To recruit, select, and educate a highly qualified diverse student body, (i.e.,
underrepresented minorities), and provide fair and equitable admission criteria;
5. Prepare physician assistant students to provide patient-centered healthcare services as part
of an inter-professional, collaborative team in a variety of clinical settings;
6. Charge physician assistant students to become graduates who reflect high standards of
legal, ethical, and moral conduct;
7. Foster the growth and development of PA education by preparing physician assistant
graduates who possess depth of knowledge, clinical skills and abilities for excellence in
practice;
8. Promote in our physician assistant students the importance of life-long learning skills and
ongoing professional development to meet and/or exceed contemporary performance
standards within their area(s) of clinical practice.
July 2015
Apply knowledge gained during the didactic year to supervised patient management.
B.
Employ a variety of learning strategies and resources to broaden clinical & social
science knowledge, interpersonal and communication skills, cultural intelligence &
professionalism.
C.
D.
Evaluate different styles of practice and specialties with a focus toward future
employment. Construct a professional CV.
E.
Develop a strategic plan of study for preparation for the National Certification for the
Commission of Physician Assistants (NCCPA) board exam (PANCE).
F.
G.
H.
I.
Develop and Demonstrate an appreciation for the diversity of the health care team
and patient populations. Assess communication skills for appropriate populations,
including the low-health literacy population.
J.
K.
L.
Comply with all rotation requirements (patient logging, EOR examinations, student
course and mid-rotation evaluations, rotation assignments, course registration,
deadlines, etc.)
M.
N.
O.
Seek advanced permission (for ANY reason) from the Director of Clinical Education
(DCE) and/or Program Director (PD) to be absent from a rotation.
P.
July 2015
There are two (2) required 8-week rotations (Primary Care and Pediatrics). Each of
these rotations will be completed during two consecutive 4-week blocks with no
exceptions.
B.
There are five (5) required 4-week rotations (General Surgery, Emergency Medicine,
Internal Medicine, Psychiatry, and Obstetrics/Gynecology).
C.
There are two (2) 4-week elective rotations in any specialty approved by the Program
Director. The first elective will be completed in conjunction with the Obstetrics/
Gynecology rotation. All students will complete elective #2 as their last rotation. It is
recommended that elective #2 be completed in the field that will enhance the
students potential to pass PANCE on the first take. Secondarily, in a field in which
the student expects to seek employment and/or with the physician with whom the
student expects to work.
PLEASE NOTE: For all rotations, requests for clinical sites are due 3 months prior to the
beginning of the rotation. If the rotation incorporates a surgical and/or hospital component,
requests for NEW sites are due 6 months prior to the rotation. The final decision on ALL
rotations is at the discretion of the Program Director and/or faculty.
Approval for requests for NEW clinical sites for the clinical year is not guaranteed.
The rotation dates and block schedules are on the following pages. Please note that each
rotation begins on a Monday and ends on a Friday. However, the last day at the clinical site
will be a Wednesday. Although your preceptor has been made aware of this fact, please
professionally remind him/her as the end of the rotation approaches. It is mandatory for the
student to be at the program office on the last scheduled day of the rotation (Friday) to
complete a rotation evaluation, end-of-rotation examination, and other learning activities as
planned. Additionally, Thursday should be available per the rotation syllabi for rotation
specific assignments. Students should expect the Friday End-of-Rotation day to last from
8am to 5pm. Attendance is mandatory! Please do not schedule any external appointments,
airline/travel plans, weddings, health appointments, etc. within the 8-5 pm time frame.
July 2015
Weeks
Completed
1
2
3
4
5
6
7
8
9
10
11
***
August 24 , 2015
September 21 , 2015
October 19 , 2015
November 16 , 2015
January 4, 2016
February 1 , 2016
February 29 , 2016
March 28, 2016
April 25, 2016
May 23, 2016
June 20, 2016
Holiday break
September 18 , 2015
October 16 , 2015
November 13 , 2015
December 11, 2015 **
January 29 , 2016
February 26, 2016 **
March 25 , 2016
April 22 , 2016 **
May 20, 2016
June 17, 2016
July 15, 2016
12/11/15 01/04/16
4
8
12
16
20
24
28
32
36
40
44
** advising
Scrub class (one hour lecture followed by two hour class on scrubbing, gowning
and gloving gloving) typically 12:30pm 3:30pm
Students need to apply for graduation by this date: February 1, 2016 (estimated)
M&A Studios to take pictures for composite: February 26, 2016
Final Deadline for all elective #2 rotations (established sites) DUE: April 1, 2016
Request for NEW elective #2 sites DUE: March 1, 2016
Request for NEW elective #2 sites (if there is a hospital component) due: January
4, 2016
July 2015
July 2015
July 2015
10
Revised 7/21/2015
July 2015
11
July 2015
12
July 2015
13
STUDENT RESOURCES
INCIDENT REPORTS
Occasionally, accidents will occur on clinical sites or in the laboratory. Should a student, patient, or
other staff member be injured as a result of an accident involving a student, the student must
comply with all accident and injury protocols established at the institution. The student may be
required to follow-up with his/her private primary care provider for further evaluation and/or
treatment. A Department of Physician Assistant Program Incident Report should be completed
immediately and filed with the director of clinical education, if the student is in the clinical phase of
the program; or the director of didactic education, if the student is in the didactic phase of the
program, no later than the Friday of the week following the incident. Additionally, students must
notify the director of clinical education or faculty member by telephone and/or e-mail of any such
incident as soon as possible. To protect the privacy of all involved parties, health information
regarding the student or patient should not be included in the documentation. Further, the form
should not contain any patient identifying data. A printed e-mail and the incident report placed in the
students file will suffice as appropriate documentation. A copy of the form is enclosed in the back of
this handbook and should be reviewed carefully (see Appendix B) and
http://www.southalabama.edu/alliedhealth/biomedical/Ravine/CAHP_Biosafety.htm
Should any expense be incurred as a result of an exposure, the student is responsible for all costs
related to the incident.
UNIVERSAL PRECAUTIONS
Upon matriculation students are required to participate in the Universitys Blood borne Pathogens
Training Module. Participation in the training course is mandatory. The course is typically taught
during the first week of classes by a faculty member. At the completion of the training module,
students are required to take an examination. Students have a total of three attempts to score 80%
or above to successfully complete the module training.
PERFORMANCE OF INVASIVE PROCEDURES
Pursuant to Section 22-11A-62 of the Alabama Code, Alabama law provides that "no health care
workers, which include students 'in the healing arts, having knowledge that he/she is infected with
either HIV or HBV shall perform or assist in the performance of an invasive procedure unless and
until he or she has notified the State Health Officer, as provided in Section 22-11A-61 [of the
Alabama Code], and agrees to cooperate with any investigation authorized in Section 22-11A-63 [of
the Alabama Code] and any necessary practice modifications." Therefore, upon enrolling in the
Physician Assistant program, any student infected with HIV or HBV must contact the State Health
Officer of the Alabama Department of Public Health (334-206-5364), or his or her designee. An
investigation and subsequent report will be completed to determine practice modifications and
limitations.
When received by the student, the final report must be presented to the director of clinical education
who will then work with the student and Special Student Services in the planning and determination
of what accommodations may be reasonably made with the parameters of the educational program.
Clinical Preceptors will be made aware of the student's practice limitations and restrictions in a
confidential manner. Failure to adhere to this policy will result in dismissal from the Program.
July 2015
14
FIRE/EVACUATION
In the event of a building evacuation, students, faculty and staff should exit via stairwells, utilizing
emergency exits and meet in designated departmental location south of the HAHN building in front
of Alpha Hall East (AHE), between AHE and University Boulevard. Students are required to review the
Emergency Evacuation Plan in Appendix A of this document carefully and participate in any
scheduled practice drills.
STUDENT SAFETY & SECURITY
The University of South Alabama Police Department is committed to the promoting and providing a
safe living, learning, and working environment for all members and guest of the University. The USA
Police Department offers numerous services to include Bicycle Registration, Fingerprinting, Crime
Reports Mapping, My Force, Operation Identification, Risk Reduction Tips and the Silent Witness
Program. Students are highly encouraged to visit the USA Police Department webpage at
http://www.southalabama.edu/police/index.html to become familiar with the many services offered.
Students should exercise caution at all times and report any suspicious activities.
WEATHER EMERGENCIES
The University of South Alabama closely monitors hazardous or potentially dangerous weather
conditions. Weather related closure or bulletins are made available from the following sources:
USA Weather line: 251.460.5999 (toll free 866.288.2139)
USA Website: www.southalabama.edu
Campus-wide email sent by the Office of Public Relations
STUDENT PARKING
All motor vehicles used on campus by students, faculty, or staff must be registered with the
University Student Accounting Office. Students will receive university related traffic regulation and a
numbered hang tag at the time of vehicle registration. Students must display their traffic hang-tag
on the rear view mirror with the front of the permit visible from the outside of the vehicle. Anyone
driving a car to the campus without a current hang-tag should obtain a temporary permit from the
University Police, and visitors should obtain visitor permits.
ACADEMIC RESOURCES
Students are highly encouraged to have a laptop, netbook, IPad, etc. The University provides a
wireless internet environment with desk plug-ins. Students should make sure they have the
Microsoft 2010 software package.
University Writing Center
http://www.southalabama.edu/writing/
The University Writing Center (230 Alpha Hall East), 460.6283 is available to all USA students.
Students may receive help on any type of writing task at any stage of the writing process. The
Centers writing consultants focus on teaching the writers. Consulting sessions are held in the
Center.
Student Health Services
http://www.southalabama.edu/studenthealth/
The Student Health Center (650 Clinic Drive, Suite 1200 of the Research Park Building III, 4607151) provides efficient and cost effective health care services relevant to the needs of the
University Community. The Center strives to accomplish this mission through health education,
health promotion and primary health care.
July 2015
15
July 2015
16
Address/Telephone Changes
It is the responsibility of each student to maintain a current local address, telephone number and
assigned USA Jagmail email address with the PA program. The CAHP and the PA program will not be
held responsible for consequences incurred due to address changes that are not reported.
BLS/ACLS
The PA program requires all students to be certified in Basic Life Support (BLS). All students must
provide the program with a copy of the BLS card upon enrollment. Re-certification must be
maintained during the complete 27 month educational program. ACLS certification and maintenance
is required for the 12-month clinical phase of the program. The program offers BLS/ACLS during the
students second summer semester as part of the Clinical Medicine IV course.
Financial Aid
http://www.southalabama.edu/finaid/
390 Alumni circle
Meisler Hall Suite 1200
1-800-305-6828 (financial aid inquiries only)
Students are encouraged to obtain financial aid, if needed, rather than seek employment during
their professional education.
July 2015
17
July 2015
18
Develop and summarize a medical history database appropriate to the presenting patient
populations.
2.
Construct, present and explain a differential diagnosis from the medical history database.
3.
4.
Demonstrate abilities to order, perform, and interpret appropriate diagnostic studies and
procedures.
5.
6.
Demonstrate and accurately perform the technical skills and/or procedures pertinent to a
given clinical discipline.
7.
With preceptor guidance, formulate and explain an appropriate patient management plan
for therapy and management of common medical/surgical problems based on individual
patient needs and circumstances.
8.
9.
Demonstrate counseling and health education appropriate to the patients and/or familys
level of comprehension, while recognizing and appropriately addressing the gender, race,
cultural, cognitive, and other biases; patient literacy, health literacy, social determinants of
health care and patient belief systems.
10. Identify, describe and construct an appropriate response to the link between patient
medical and socioeconomic problems. Using an interprofessional healthcare team
approach, utilize community resources to make appropriate referrals within the community.
SPECIFIC OBJECTIVES
(I)
July 2015
5.
6.
7.
8.
Social history
Sexual history
Family history
Review of systems
General condition
Vital signs
Skin
HEENT
Neck
Breast and chest wall
Cardiovascular
8.
9.
10.
11.
12.
13.
14.
Pulmonary
Abdomen
Genito-urinary
Rectal
Musculoskeletal
Neurological
Mental status
C. Devise and explain pertinent positive and negative findings to the preceptor and/or
the medical/surgical team in an appropriate, clear, and concise manner.
(II)
After generating a thorough database the student shall write a succinct problem list with
appropriate discussion of clinical rationale, diagnostic strategies and therapeutic
considerations.
A. The student will demonstrate and document the following in an appropriate format:
1. Admission history and physical
2. Orders
a. admission
b. pre-operative
c. post-operative
d. discharge
3. Notes
a. admission
b. on-service
c. off-service
d. delivery
e. pre-operative
f. post-operative
g. intensive care unit
h. procedure
4. Discharge summary
All medical documentation MUST be reviewed, approved and countersigned by the preceptor.
B.
July 2015
The student will demonstrate the ability to explain the socioeconomic, health literacy
and cultural needs of the patient, and their family appropriately to help maximize
available resources within the community. Students will also practice the appropriate
protocol for referring patients and families to services available in the community
(speech therapy, occupational therapy, physical therapy, counseling, and other
medical/surgical specialties).
20
Construct a thorough history and physical data using either formal or bullet style as
appropriate.
B.
July 2015
21
July 2015
22
July 2015
23
6.
7.
Attend hospital conferences, lectures and all patient- care team meetings.
Assume overnight call as assigned by the preceptor but not more often than
once every third night.
Students should anticipate spending several hours per week reviewing pertinent anatomy,
disease processes, and treatments for the hospitalized, adult, internal medicine patient.
Additionally, students should refer to suggested readings and participate in independent
learning to obtain a breadth and depth of knowledge concerning adult inpatient/outpatient
experiences unique to general internal medicine.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all
learning objectives stated below.
COURSE GOALS: The goal of PA 550 is to provide practical experience in the discipline of
Internal Medicine that will foster translation of knowledge gained in the didactic curriculum
to the care of the internal medicine patients in the hospital and outpatient settings. The
essential knowledge gained from the preclinical courses to be applied in the internal
medicine rotation includes:
1. Clinical manifestations of the most common emergent, urgent, medical conditions
requiring internal medicine management.
2. Basic anatomical structures and their neurovascular relationships relevant to
common medically managed diseases.
3. Physiological principles of fluid and electrolyte balance, their management and
replacement.
4. Principles of hemodynamic monitoring.
5. Hemodynamic and hematological principles associated with blood loss, replacement,
and cardiac function.
6. Normal renal anatomy and physiology, action of diuretics, hormonal responses in salt
and water metabolism.
7. Normal and abnormal endocrine function related to the internal medicine patient.
8. Cardiovascular, pulmonary and gastrointestinal pathophysiology related to the
diagnosis and treatment of common medical disorders encountered in the medical
patient
9. Principles of pharmacologic and non-pharmacologic treatment related to medical
patient management.
By the end of this course, the student will:
1. Formulate a complete and accurately focused patient history including belief
systems, spiritual and cultural issues and incorporate these into the comprehensive
care of an internal medicine patient.
2. Determine appropriate physical examination techniques, laboratory tests, radiologic,
and other clinical studies based on a presenting history and physical examination,
and interpret the results.
July 2015
24
3. Formulate appropriate differential diagnoses for the internal medicine patient based
on presenting history, physical examination, and investigative studies.
4. Synthesize and present to the preceptor, PA faculty and PA students a written and
oral description of the patient's clinical condition based upon the information
obtained from the patient and other resources.
5. Differentiate the medical presentation of common disease processes, and plan and
manage their appropriate pre-admission work-up, hospital stay, and posthospitalization care.
6. Create and maintain clear and accurate patient record documentation over the
course of the patients illness.
7. Demonstrate competency in basic procedures and technical skills utilized in the
care of the internal medicine patient.
8. Illustrate clear and accurate patient education.
9. Display appropriate professional and ethical behaviors and skills required of
Physician Assistants in the inpatient/outpatient environment.
July 2015
25
STUDENT EXPECTATIONS
INPATIENT DUTIES:
1.
On the first day of inpatient wards, the student should ask the preceptor to provide an
orientation to the hospital/clinic/emergency department. This orientation should include fire
and safety protocol.
2.
Each student will be assigned new patients upon admission for whom he or she is expected to
perform a complete evaluation.
a. The history and physical examination should be performed and recorded according to the
supervising physician and/or site expectation.
b. The initial work-up should include a detailed problem list, discussion of the differential
diagnosis, and initial management plan.
c. Review all pertinent physical examination, laboratory and diagnostic findings with the
supervising physician. Record these findings in the medical record.
d. The above information should be presented in an oral case presentation to the
supervising physician.
3.
The student should collaborate with the supervising physician to construct or update a
problem list for each of their patients.
4.
Daily progress notes on the students patients should be written using a problem-oriented
approach.
a. All notes must be dated, timed and signed by the student.
b. All notes must be countersigned by the supervising physician.
5.
The student has a unique opportunity to impact the emotional well-being of the patient.
Addressing non-medical aspects of patient care are essential.
a. Students should be aware of consultation for social services in the hospital.
b. Students should be aware of social services available within the community.
c. Students should recognize cultural and socioeconomic differences in patients/families
that may influence perceptions of wellness, disease, and treatment modalities.
d. Students should adhere to programmatic standards of professional interactions between
patients, other members of the healthcare team and staff.
6.
Students should attend all educational conferences, meetings, and lectures offered at the
clinical site.
7.
Students are expected to take call at least one night a week if it is available on their service.
8.
The student is responsible for maintaining a patient log in Typhon Group, to include data (at a
minimum) of: rotation type, rotation site, preceptor, date, age, gender, diagnoses (ICD-9
codes) and procedures (CPT codes).
OUTPATIENT DUTIES:
1.
2.
3.
4.
5.
When assigned to internal medicine outpatient services, the student is expected to work the
same hours as that of the supervising physician or clinic.
On the first day of clinic, the student should ask the preceptor or office manager to provide an
orientation to the clinic. This orientation should include fire and safety protocol.
If the preceptor is taking call during the weekend, the student is expected to take call as well.
The student is responsible for asking the supervising physician for written and verbal
feedback regarding his/her progress at mid-rotation.
The student is responsible for reading medical literature/textbooks regarding the objectives
and diagnoses listed in this syllabus. Furthermore, the student is responsible for making oral
presentations to the supervising physician and asking pertinent questions regarding these
objectives on a regular basis.
July 2015
26
I. Medical Knowledge
A. As they relate to commonly seen medically managed diseases, at the completion of the
rotation the physician assistant student will be able to describe, identify, describe,
formulate, create, explain, construct and distinguish the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
B.
July 2015
analgesics
anti- arrhythmic drugs
antacids, acid pump inhibitors
antibiotics
antiretroviral meds
antifungals
bronchodilators
anti-hypertensive drugs
anti-diabetic medications including insulin
anticoagulants
corticosteroids
27
II. Skills
A.
By the completion of this rotation it is expected that the Physician Assistant student
will be able to competently demonstrate, perform, elicit, formulate, interpret,
synthesize, and document the following general patient management skills:
1.
2.
3.
4.
5.
6.
7.
July 2015
28
d.
e.
f.
g.
h.
i.
C. Patient education
1. Formulate patient education for hospitalized patients regarding their specific
conditions, treatment plans, and measures to maintain their health
2. Summarize and provide clear discharge planning and follow-up care instructions
III. PROFESSIONAL AND ETHICAL BEHAVIORS AND SKILLS
A. The Physician Assistant student will exhibit the following professional and ethical
behaviors:
1. Adhere to all HIPPA and confidentiality rules
2. Document patient information accurately and honestly
3. Critique written medical documentation for errors, assume responsibility and correct
any medical errors in a timely and appropriate manner
4. Support patient safety measures at all times in the clinical setting
5. Demonstrate professionalism at all times when working with patients, staff and other
members of the health care team
6. Assume responsibility at all times in areas of preparedness, attendance, demeanor
and dress
7. Demonstrate a willingness to help any member of the team until the task is
completed (duty)
8. Demonstrate evidence of independent student learning relating to problems
encountered in the clinical setting
B. The Physician Assistant student will demonstrate the following professional attitudes:
1. Considerations of to the emotional and social backgrounds of patients and their
families
2. Commitment to caring for all patients regardless of gender, race, socioeconomic
status, intellect, sexual orientation, or ability to pay
3. Willingness to ask for help from healthcare staff when appropriate and to utilize
ancillary resources
4. Openness to recognize limitations by using resource referrals and consultation with
supervising preceptor when appropriate
5. Openness to receiving constructive criticism
6. Considerations of patients perceptions of health and illness as they relate to patient
care
July 2015
29
July 2015
30
___
Faculty Advisor:________________
Date:
Grade:______/56
July 2015
31
Average (5 points)
Identifying Data
Includes vocational
history, current living
situation,
tobacco/alcohol/drug
history, & medical history
of first degree relatives.
Includes all systems
Includes a majority of
systems
Includes a majority of
appropriate labs.
Identifies some
abnormalities.
Review of Systems
Laboratory Evaluation
Physical Examinations
Each problem is
addressed, either
separately or as a
constellation of problems,
and a differential
diagnosis is provided for
each problem or problem
constellation. Use of
tests is discussed for
each major problem. A
complete, reasonable
plan for each problem is
suggested.
Structure
No spelling and/or
grammar errors
July 2015
32
July 2015
33
5.
6.
7.
Students should anticipate spending several hours per week reviewing patient counseling
techniques and coping mechanisms, the multi-axial evaluation/classification system (DSMIV), disease processes, and treatments for the psychiatric patient. Additionally, students
should refer to suggested readings and participate in independent learning to obtain a
breadth and depth of knowledge concerning inpatient/outpatient experiences unique to
psychiatric medicine.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all
learning objectives stated below.
COURSE GOALS: The goal of PA 555 is to provide practical experience in the recognition and
management of the patient with pathologic Psychiatric/ Behavioral Medicine that will foster
translation of knowledge gained in the didactic curriculum to the care of the psychiatric
patients in the hospital and outpatient settings. The essential knowledge gained from the
preclinical courses to be applied in the psychiatry rotation includes:
1. Clinical manifestations of the most common emergent, urgent, conditions requiring
psychiatric management.
2. Principles of pharmacologic treatment related to psychiatric and therapeutic patient
management.
3. Care, support and education of the patient and the patients family members and
significant others.
4. Apply and reinforce basic and more advanced psychiatric concepts to properly treat
future patients competently; independent of practice setting.
By the end of this course, the student will:
1. Perform an adequate mental status examination including a complete medical,
psychiatric, and social history.
2. Formulate a complete and accurately focused age-appropriate patient history
including belief systems, spiritual and cultural issues and incorporate these into the
comprehensive care of a psychiatric patient.
3. Determine and interpret finding from appropriate psychological testing and other
clinical studies based on presenting history.
4. Perform appropriate physical examination techniques, laboratory tests and radiologic
studies as pertinent, and interpret the results.
5. Formulate age-appropriate differential diagnoses for the psychiatric patient based on
presenting history, and investigative studies.
6. Synthesize and present to their preceptor, a written and oral description of the
patient's clinical condition based upon the information obtained from the patient and
July 2015
34
other resources.
7. Differentiate the presentation of common psychiatric disease processes.
8. Demonstrate a working knowledge of treatment plan development for inpatient and
outpatient treatment in child, adolescent, adult, and geriatric populations.
9. Demonstrate awareness of complications of both medication management and
psychotherapy.
10. Demonstrate an ability to determine the least restrictive, but most therapeutically
beneficial treatment setting based on various degrees of patient acuity.
11. Create and maintain clear and accurate patient record documentation over the
course of the patients illness.
12. Demonstrate competency in basic procedures and technical skills utilized in the care
of the psychiatric patient.
13. Illustrate clear and accurate patient education.
14. Demonstrate an understanding of patient restraints and limitations imposed on the
physician and patient due to financial, insurance, and medico-legal issues.
15. Display appropriate professional and ethical behaviors and skills required of
Physician Assistants in the Psychiatric/Behavioral Medicine setting.
COURSE GRADE:
Preceptor evaluation 30% of grade
Multiple-choice Psychiatric examination 30% of grade
Quizzes/TBL provided by Altapointe faculty 10 % of grade
Oral case presentation to Altapointe preceptor 5% of grade
Computer based Typhon Group patient tracking 10% of grade
Clinical Coordinator Evaluation 5% of grade
Mid-rotation evaluation by preceptor 10% of grade
July 2015
35
STUDENT EXPECTATIONS:
INPATIENT DUTIES:
1. On the first day of the rotation, the student should ask the preceptor to provide an orientation
to the facility. This orientation should include fire and safety protocol.
2. Each student will be assigned new patients upon admission for whom he or she is expected
to perform a complete evaluation.
a. The history and physical examination should be performed and recorded according to
the supervising physician and/or site expectation.
b. The initial work-up should include a detailed problem list, discussion of the
differential diagnosis, and initial management plan.
c. Review any pertinent prior counseling and treatment plans, physical examination,
laboratory and diagnostic findings with the supervising physician. Record these
findings in the medical record.
d. The above information should be presented in an oral case presentation to the
supervising physician.
3. The student should collaborate with the supervising physician to construct or update a
problem list for each of their patients.
4. Daily progress notes on the students patients should be written using a problem-oriented
approach.
a. All notes must be dated, timed and signed by the student.
b. All notes must be countersigned by the supervising physician.
5. The student has a unique opportunity to impact the emotional wellbeing of the patient.
Addressing non-medical aspects of patient care are essential.
a. Students should be aware of consultation for social services in the hospital.
b. Students should be aware of social services available within the community.
c. Students should recognize cultural and socioeconomic differences in
patients/families that may influence perceptions of wellness, disease, and treatment
modalities.
d. Students should adhere to programmatic standards of professional interactions
between patients and other members of the healthcare team and staff.
e. Students should demonstrate an appropriate attitude toward mental and emotional
illness, the patient, family, nursing, therapy staff, and other members of the
treatment team.
f. Students should adhere to the principles of confidentiality and informed consent.
6. Students should attend all educational conferences, meetings, and lectures offered at the
clinical site.
7. The student is responsible for asking the supervising physician for written and oral feedback
regarding his/her progress at mid-rotation.
8. Students should demonstrate respect for and recognition of skill sets of the interprofessional
healthcare team.
9. Students are expected to take call at least one night a week if it is available on their service.
10. The student is responsible for maintaining a patient log in Typhon Group, to include data (at a
minimum) of: rotation type, rotation site, preceptor, date, age, gender, diagnoses (ICD-9
codes) and procedures (CPT codes).
July 2015
36
OUTPATIENT DUTIES:
1. When assigned to psychiatric outpatient services, the student is expected to work the same
hours as that of the supervising physician or clinic.
2. On the first day of clinic, the student should ask the preceptor or office manager to provide
an orientation to the clinic. This orientation should include fire and safety protocol.
3. If the preceptor is taking call during the weekend, the student is expected to take call as well.
4. The student is responsible for asking the supervising physician for written and oral feedback
regarding his/her progress at mid-rotation.
5. The student is responsible for reading medical literature/textbooks regarding the objectives
and diagnoses listed in this syllabus. Furthermore, the student is responsible for making oral
presentations to the supervising physician and asking pertinent questions regarding these
objectives on a regular basis.
At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and when appropriate provide the rationale needed to
diagnose and treat diseases seen in the psychiatric discipline in the hospital, clinic, and
outpatient settings across the lifespan of patients (childhood, adolescent, adult, and
elderly). The student will be able to discuss and explain the following aspects of any
given psychiatric diagnosis as listed above:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
July 2015
14.
15.
II. Skills
A. By the completion of this rotation it is expected that the Physician Assistant student will
be able to competently demonstrate, perform, elicit, formulate, interpret, synthesize and
document the following general patient management skills:
1.
2.
3.
4.
38
July 2015
39
July 2015
40
July 2015
41
participation of the patient. Clarifying statements used to keep the patient on task
are positive signs of a skillful interview.
5. Clarity and Organization of Presentation
The student should present a clear, concise, and organized outline of a patient which
is easy to follow and includes all data necessary to justify the diagnosis given. The
student should avoid repeating data, or including data that has no immediate
relevance to the case.
6. Differential Diagnosis/Formulation
The student should be able to discuss a complete DSM-IV differential diagnosis of the
patient's problem and provide justification for the diagnosis given. The student
should be able to discuss the biopsychosocial factors pertinent to the patient's
problem. She/he should be able to discuss both predisposing and precipitating
factors to the patient's episode of illness
7. Treatment Plan
The student should be able to discuss a basic treatment plan for the patient
including biological, social, and psychological interventions
July 2015
42
July 2015
43
During newborn nursery care, students are exposed to an array of clinical experiences,
including, procedures, history-taking, diagnostics, and clinical management. The pediatric
emergency rotation prepares the student in comprehensive emergency care to patients less
than age 21 years in consultation with medical and surgical specialties. This clinical
experience allows the student to expand their knowledge base, critical-thinking skills, and
clinical decision making.
Students should anticipate spending several hours per week reviewing pertinent disease
states and treatments for the pediatric patient. Students should demonstrate independent
learning to augment their clinical knowledge regarding common pediatric diseases,
diagnosis, and management, pediatric normal and abnormal growth and development, and
principles of health supervision.
While on this rotation the student is expected to:
1. Conduct an age-appropriate history
2. Perform an age appropriate physical examination
3. Recognize ramifications of the parent as historian in obtaining a medical history
in a pediatric patient
4. Assess pediatric chief complaint(s)
5. Develop appropriate differential diagnosis of illness
6. Demonstrate clinical skill and competency in medical diagnosis and management
of pediatric patients in ambulatory, inpatient, and emergency settings
7. Perform and interpret diagnostic tests and procedures
8. Explain appropriate anticipatory guidance
9. Provide appropriate follow-up care
COURSE GOALS: The goal of PA 560 is to provide the student with practical experience in
the general pediatric field, while also exposing students to consultations in various
subspecialties of pediatrics medicine, which will allow them to demonstrate knowledge of
established and evolving biomedical, clinical and social sciences, and the application of
their knowledge to pediatric patient care, which includes health promotion and disease
prevention
The essential knowledge gained from the preclinical courses to be applied in the pediatric
rotation includes:
1. Knowledge and skills in pediatric history-taking and physical examination skills.
2. Ability to develop appropriate differential diagnoses for the pediatric patient
based on patient history, physical examination, and diagnostic tests.
3. Knowledge of the components of a health supervision visit for the pediatric
patient, to include age-appropriate anticipatory guidance about nutrition,
behavior, immunizations, developmental milestones, injury prevention, pubertal
development, sexuality and substance use and abuse.
4. Psychosocial, language, physical maturation, and motor development in pediatric
patients.
July 2015
44
July 2015
45
1.
2.
3.
4.
5.
6.
7.
8.
July 2015
46
In order to introduce you to your team we ask you to be at the classroom a few minutes earlier.
Adapted from PSU Interprofessional Module Education (Creative Commons License)
Please see page # 126 for other rotation grading information.
STUDENT EXPECTATIONS:
DUTIES:
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
July 2015
When assigned to Pediatric outpatient services, the student is expected to work the same
hours as that of the supervising physician or clinic.
On the first day of clinic, the student should ask the preceptor or office manager to
provide an orientation to the clinic. This orientation should include fire and safety
protocol.
Each student will be assigned new patients for whom he or she is expected to perform a
complete evaluation.
a. The history and physical examination should be performed and recorded according to
the supervising physician and/or site expectation.
b. The initial work-up should include a detailed problem list, discussion of the
differential diagnosis, and initial management plan.
c. Review all pertinent physical examination, laboratory and diagnostic findings with the
supervising physician. Record these findings in the medical record.
d.The above information should be presented in an oral case presentation to the
supervising physician.
The student should collaborate with the supervising physician to construct or update a
problem list for each of their patients.
All notes must be dated, timed and signed by the student.
All notes must be countersigned by the supervising physician.
The student has a unique opportunity to impact the emotional well being of the patient.
Addressing non-medical aspects of patient care are essential.
Students should be aware of social services available within the community.
If the preceptor is taking call, the student is expected to take call as well. The
expectation is that the student should take call at least one night per week.
The student is responsible for asking the supervising physician for feedback regarding
his/her progress halfway through the rotation.
Students should attend all educational conferences, meetings, and lectures offered at
the clinical site.
Students should be aware of social services available within the community.
47
18.
19.
20.
21.
ROTATION OBJECTIVES:
I. MEDICAL KNOWLEDGE
A.
At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and provide the rationale needed to diagnose and treat
diseases seen in the pediatric discipline in the clinic and/or hospital settings. The
student will be able:
10. Describe definition and overview of commonly seen medically managed diseases
in pediatrics
11. Identify etiology as appropriate
12. Describe epidemiology, pathogenesis, pathophysiology and clinical presentation
of disease (s)
13. Formulate age appropriate diagnosis
14. Create a management plan based on appropriate use and interpretation of
diagnostic test, medications, and other medical interventions
15. Explain complications of the disease diagnosed, medical treatments, and
comorbid disease states
16. Explain prognosis including the outcomes of treatment versus no treatment
versus watchful waiting
17. Construct age appropriate patient education and discharge planning
18. Describe common developmental disorders
3.
List the most common preventable morbidities that occur during childhood and
describe strategies for prevention.
Describe the components of a health supervision visit including health promotion and
disease and injury prevention, the appropriate use of screening tools, and
immunizations for newborns, infants, toddlers, school aged children, and
adolescents.
Describe the rationale for childhood immunizations.
July 2015
48
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Discuss the rational for screening tests (such as environmental lead questionnaire,
domestic violence screening, CBC, urinalysis, blood lead level, and PPD).
Describe the age at which each of the following should occur, indications,
appropriate use, interpretation, and limitations of the following screening tests:
Neonatal screening
Developmental screening
Hearing and vision screening
Lead screening
Anemia screening
Tuberculosis testing
Define anticipatory guidance and describe how it varies based on the age of the
child.
Describe variants of normal growth in healthy children, (e.g. familial short stature and
constitutional delay).
Identify and describe abnormal growth patterns based on the family growth history
and the childs previous growth (e.g. microcephaly, macrocephaly, short stature,
obesity), and growth abnormalities related to specific physical findings.
Identify failure to thrive and overweight/obesity in a child or adolescent using BMI
and other growth measures. Construct an appropriate differential diagnosis and
initial evaluation.
Describe the four developmental domains of childhood as defined by the Denver
Developmental exam (e.g. gross motor, fine motor, language, and social
development).
Describe how abnormal findings on the development screening tools would suggest a
diagnosis of developmental delay such as, autism, pervasive developmental delay,
and mental retardation.
Describe the initial evaluation and need to refer a patient with evidence of
developmental delay or abnormality.
Identify normal pattern of behaviors in the developing child such as:
Newborn infants: development and evolution of social skills
Toddler: autonomy
School age: independence
Adolescence: abstract thinking
Describe the typical presentation, diagnosis, and management of common
behavioral problems in different age groups such as:
Newborn/infants: sleep problems, colic
Toddler: temper tantrums, toilet training, feeding problems
School age: enuresis, attention deficit, encopresis, autism
Adolescence: eating disorders, risk-taking behavior, conduct disorders
Describe emotional disturbances or medical conditions that may manifest as
alterations in school performance and peer or family relationships due to violence
and/or dysfunction in the home. Describe interventions.
Distinguish between age-appropriate behavior, inappropriate or abnormal behavior,
and those that suggest severe psychiatric or development illness in children of
different ages (for example head banging, threatening gestures, suicidal).
July 2015
49
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
ADOLESCENT HEALTHCARE
30.
31.
32.
33.
34.
35.
July 2015
50
36.
37.
38.
NEWBORN PEDIATRICS
39.
40.
41.
42.
43.
List the information from the history of pregnancy, labor, and delivery obtained from
the parents or medical record that has implications for the health of the newborn.
Describe how gestational age can be assessed and identify key indications of
gestational maturity.
Describe the challenges for parents adjusting to a new infant in the home.
List the differential diagnosis, complications and possible management plan for the
following common problems that may occur in the newborn:
Jaundice
Respiratory distress
Poor feeding
Large and small size for gestation infants (e.g. congenital infection)
Abnormalities, which includes: tremulousness, irritability, lethargy from
causes such as drug withdrawal, hypoglycemia, sepsis, prematurity
Describe how gestational age affects risks of morbidity or mortality in the newborn
period (e.g., lung disease, hypothermia, and glucose homeostasis)
45.
46.
Describe the genetic basis and clinical manifestations of the following syndromes,
malformations, and associations:
Common chromosomal abnormalities, (e.g. Trisomy 21, Turner syndrome,
Klinefelter syndrome)
Syndromes due to teratogens (e.g. fetal alcohol syndrome)
Other common genetic disorders (e.g. cystic fibrosis, sickle cell disease,
hemophilia)
Single malformations with multifactorial etiology (e.g. spina bifida,
congenital heart disease, cleft lip and palate)
List common medical and metabolic disorders (e.g. hearing loss, hypothyroidism,
PKU, hemoglobinopathies) detected through newborn screening programs and
describe the appropriate treatment plan.
Discuss the effects of maternal health and potentially teratogenic agents on the
fetus and child, including maternal diabetes, age, alcohol use, illicit drug use, and
prescribed medications such as phenytoin, valproate, and retinoic acid.
July 2015
51
47.
48.
49.
List the age appropriate epidemiology, clinical, laboratory, radiographic findings, and
differential diagnosis for pediatric patients presenting with each of the following:
o
o
o
o
o
o
o Abdominal pain
o Lethargy or irritability
o Cough and/or wheeze
o Limp or extremity pain
o Diarrhea
o Otalgia
o Fever and Rash
Fever without a source
Rhinorrhea
Headache
Seizures
Sore throat
Vomiting
July 2015
52
51.
52.
53.
54.
55.
56.
57.
58.
59.
List the age appropriate epidemiology, clinical, laboratory, radiographic findings, and
differential diagnosis for pediatric patients presenting with each of the following:
Abdominal mass
Bruising
Heart murmur
Hepatomegaly
Lymphadenopathy
Splenomegaly
Petechiae and/or purpura
Red or wandering eye
White pupillary reflex
List the age appropriate epidemiology, clinical, laboratory, radiographic findings, and
differential diagnosis for pediatric patients presenting with each of the following:
Anemia
Hematuria
Proteinuria
Positive Mantoux skin test (PPD)
Explain how the physical manifestations of disease and the evaluation and
management may vary based on age of the pediatric patient. Be able to give specific
examples.
Discuss the criterion for decision-making regarding treating the pediatric patient in
the hospital or outpatient setting.
Describe the clinical features, epidemiology, diagnosis, and management of common
male and female genitourinary problems seen in pediatrics.
Describe the clinical features, epidemiology, diagnosis, and management of chronic
medical conditions seen in pediatrics, such as:
Asthma
Atopic dermatitis
Cerebral palsy
Cystic fibrosis
Diabetes mellitus
Epilepsy
Malignancy (e.g. acute lymphocytic leukemia and Wilms tumor)
Obesity
Seasonal allergies
Sickle cell disease
HIV/AIDS
Sensory impairment
Describe how chronic illness can influence a childs growth and development,
educational achievement, and psychosocial functioning.
Describe the impact that pediatric chronic illness has on the familys emotional,
economic and psychosocial functioning.
Describe the impact of family culture on the understanding, reaction to, and
management of a pediatric chronic illness.
53
60.
Describe the contributions of each member of a multidisciplinary health care team in
caring for children with a chronic illness.
61.
Identify the key components of delivering Bad News in relation to chronic illness.
62.
Explain the advantages and disadvantages of breast feeding vs. bottle feeding.
THERAPEUTICS IN THE PEDIATRIC POPULATION
63.
64.
65.
66.
67.
Describe the conditions in which fluid administration may need to be restricted (such
as the SIADH secretion, congestive heart failure, or renal failure) or increased (e.g.
fever).
July 2015
54
69.
70.
Describe the physical findings in hypovolemic shock and the approach to restoration
of circulating fluid volume (i.e.rescue fluid infusion)
Describe the causes and consequences of fluid imbalances and electrolyte
disturbances leading to dehydration (e.g., hypernatremia, hyponatremia,
hyperkalemia, hypokalemia, and severe acidosis).
PEDIATRIC EMERGENCIES
76.
77.
78.
79.
80.
July 2015
55
82.
83.
84.
85.
List characteristics of the history and physical examination that should trigger
concern for possible physical, sexual, and psychological abuse and neglect e.g. such
as inconsistency in the history, unexplained delays in seeking care, injuries with
specific patterns or distributions on the body, or injuries incompatible with the childs
development.
Describe the medical-legal importance of a full, detailed, carefully documented
history and physical examination in the evaluation of child abuse.
Discuss the concurrence of domestic violence and child abuse and describe markers
that suggest the occurrence of family violence.
Describe the unique communication skills required to work with families around
issues of maltreatment.
Summarize the responsibilities of the mandatory reporter to identify and report
suspected child abuse. Describe appropriate reporting protocol.
7.
8.
Toddler/school age child: milk, juice, soda, fast foods, and meal patterns
July 2015
56
Breastfeeding vs. formula feeding
Circumcision
16.
Evaluate a family history to determine the possibility of a possible genetic disorder.
17.
Perform an age-appropriate history and physical examination pertinent to the
presenting complaint of the child.
18.
Generate an age appropriate differential diagnosis and initial diagnostic and
therapeutic plan for each patient presenting with one of the following symptoms,
physical examination findings, or laboratory findings:
o Abdominal pain
o Fever, no source
o Cough and/or wheeze
o Lethargy or irritability
o Diarrhea
o Limp or extremity pain
o Fever and rash
o Otalgia
July 2015
57
o
o
o
o
o
o
19.
20.
21.
22
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
July 2015
58
36.
B.
Analgesics, antipyretics
generics
antimicrobials
cold/cough medications and other over-the-counter meds
antifungals
antivirals
bronchodilators and other asthmatic medications
antihypertensives
antidiabetic medications including insulin
psychiatric drugs
corticosteroids
ophthalmic preparations
otic preparations
vitamin/mineral supplements
II. SKILLS
A. By the completion of this rotation it is expected that the physician assistant student will
be able to:
8. Demonstrate an ability to obtain an age appropriate history for the presenting chief
complaint.
9. Perform an age appropriate physical exam for the presenting chief complaint
10. Select appropriate laboratory and radiologic diagnostic studies
11. Formulate an appropriate differential diagnosis and treatment plan utilizing data
gathered in the history, physical examination and investigative studies
12. Display critical-thinking and problem-solving skills
13. Demonstrate understanding of influence of family, community and society throughout
the lifespan of pediatrics
14. Write age appropriate complete history and physical examination
15. Write age appropriate progress note
16. Demonstrate ability to give age appropriate oral pediatric case presentation
B. Demonstrate and document in written or EMR format the following:
6. Appropriately focused general medical admission history and physical examination
7. Admission orders
8. Brief and Full procedure notes
July 2015
59
July 2015
60
D. Patient Education
1. Provide patient education
3. Formulate patient education for hospitalized patients regarding their
specific conditions, treatment plans, and measures to maintain their
health.
4. Formulate patient education for ambulatory patients to include nutrition,
immunizations, poisonings, safety, risky behaviors, growth & development,
exercise, health promotion and disease prevention
5. Anticipate and provide clear discharge planning and follow-up care
instructions
III. PROFESSIONAL AND ETHICAL BEHAVIORS AND SKILLS
A. The Physician Assistant student will exhibit the following professional and ethical
behaviors:
9. Adhere to HIPPA and confidentiality rules
10. Document patient information accurately and honestly
11. Identify errors, assume responsibility and correct any errors in an appropriate
manner
12. Display professionalism at all times when working with pediatric patients, their
families, staff and other members of the health care team
13. Assume responsibility at all times in areas of preparedness, attendance, demeanor
and dress
14. Display a willingness to help any member of the team until the task is completed
(duty)
15. Demonstrate evidence of independent student learning relating to problems
encountered in the clinical setting
B. The Physician Assistant student will demonstrate the following professional attitudes:
7. Consideration of the emotional and social backgrounds of patients and their families
8. Commitment to caring for all patients regardless of gender, race, socioeconomic
status, intellect, sexual orientation, or ability to pay
9. Willingness to ask for help from healthcare staff when appropriate and to utilize
ancillary resources
10. Openness to recognize limitations by using resource referrals and consultation with
supervising preceptor when appropriate
11. Openness to receiving constructive criticism
12. Considerations of pediatric patient and family/caregiver perceptions of health and
illness as they relate to the patients care.
IV. PRACTICE-BASED LEARNING
The successful PA student will demonstrate the ability to:
5. Continuously evaluate patient care practices, and appraise and assimilate scientific
evidence, in order to improve the practice of medicine and ensure the safety and
quality of patient care
July 2015
61
July 2015
62
___
Faculty Advisor:________________
Date:
Grade:______/56
July 2015
63
Average (5 points)
Identifying Data
Includes vocational
history, current living
situation,
tobacco/alcohol/drug
history, & medical history
of first degree
relatives.**
Includes all systems
Includes a majority of
systems
Includes a majority of
appropriate labs.
Identifies some
abnormalities.
Review of Systems
Laboratory Evaluation
Physical Examinations
Each problem is
addressed, either
separately or as a
constellation of problems,
and a differential
diagnosis is provided for
each problem or problem
constellation. Use of
tests is discussed for
each major problem. A
complete, reasonable
plan for each problem is
suggested.
Structure
No spelling and/or
grammar errors
July 2015
64
July 2015
Conduct a focused history and physical exam, rather than the comprehensive
H&P.
Participate in daily patient assessment and medical management over the
course of the patients outpatient stay.
Participate as part of an interprofessional team providing patient-centered65
4.
5.
6.
7.
Students should anticipate spending several hours per week reviewing pertinent anatomy,
disease processes, and treatments for the primary care patient. Additionally, students
should refer to suggested readings and conduct independent learning to obtain the breadth
and depth of knowledge concerning objectives/cases in primary care medicine which were
not observed during the rotation.
The student will report to the physician assistant program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all
learning objectives stated below.
COURSE GOALS: The goal of PA 570 is to provide practical experience in the discipline of
primary care that will foster translation of knowledge gained in the didactic curriculum, to
the care of the primary care patients in the outpatient and/or hospital settings. The
essential knowledge gained from the preclinical courses to be applied in the primary care
rotation includes:
1. Principles of family medicine care, continuity of care, and the role of the family
physicians.
2. Clinical manifestations of the most common acute, chronic, or preventive
medical conditions requiring primary care management.
3. Management of patients with multiple medical concerns, various psychosocial
issues, and behaviors that influence their health and health care.
4. Management of follow-up visits with patients having one or more common
chronic diseases.
5. Drug dosages and prescription writing in across the patient lifespan.
6. Pharmacological and non-pharmacological plans, appropriate patient
counseling, screening and follow-up plan.
7. Criterion for appropriate referral services.
8. Evidence-based health promotion/disease prevention plans for patients of any
age or gender.
9. Competency in advanced elicitation of history, communication, physical
examination, critical-thinking and problem-solving skills.
10. Appropriate interpersonal and communication skills
11. Principles of pharmacologic treatment related to medical patient
management.
July 2015
66
July 2015
67
The Case-Based Learning assignment will be presented on the last Thursday of the rotation
from 1 p.m. to 3 p.m. This will count for 15% of the final rotation grade.
The clinical student will interact with faculty, students or peers by preparing a 15
minute case-based learning assignment for a group. The patient profile should be
selected based on a patient seen during the primary care rotation with the assistance
and approval of their preceptor. The profile should include all the pertinent
information initially from the patient chief complaint, history of present illness, and
review of symptoms. This information will be used to begin the group discussion.
The clinical student should help by providing facts of the patient to lead the group
toward a differential, and ultimately a working diagnosis. The discussion should
continue including which questions the provider would ask the patient, which lab
and/or imaging studies should be ordered and why. Ultimately once the final
diagnosis is determined, the conversation should move towards assessment and
plan, patient education and follow-up/referral
July 2015
68
Date:
Faculty:
Grade: __
/25
A. Purpose
a. Case-based learning (CBL) uses a guided inquiry method. The Center for Instructional
Development & Distance Education, retrieved 19:35, 11 October 2007 (MEST)
defines CBL as the following: Cases are factually based, complex problems written
to stimulate classroom discussion and collaborative analysis. Case teaching involves
the interactive, student- centered exploration of realistic and specific situations. As
students consider problems from a perspective which requires analysis, they strive to
resolve questions .
B. Requirement
The Case-Based Learning (CBL) assignment will be presented on the last Thursday of the
rotation from 1 p.m. to 3 p.m.
C. Grade 25 points
Criteria:
Appropriate selection of patient profile and organization of CBL assignment
(5points): the patient profile selected was appropriate for a case-based
learning assignment. The CBL was well organized to flow logically and
contain all the necessary patient, medical and assessment information as
indicated.
Knowledge regarding CBL patient and diagnosis (5points): during the
presentation, the clinical student demonstrated knowledge and in depth
understanding of the patient's present illness, past medical history, diagnosis
and treatment. Knowledge was such that independent research had been
conducted to conduct class discussion.
Professional attire and presence (5points): the student was well prepared for
the CBL, including professional attire, demeanor, handling of sensitive
cultural and medical information, and overall presence during the
presentation. The student modeled professional behavior to the didactic
students during the course of the CBL.
Demonstrated effective communication skills (5points): during the CBL the
student exhibited effective communication skills through verbal and
nonverbal communication with the class. Eye contact was maintained, voice
inflection was utilized when appropriate, proper usage of technical and/or
classroom materials were utilized. Engaged didactic student participation
during the course of the CBL.
Ability to answer questions and maintain discussion (5points): the student
was able to utilize critical thinking skills during the CBL by answering
questions and maintaining classroom discussion.
July 2015
69
STUDENT EXPECTATIONS:
DUTIES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
July 2015
When assigned to primary care outpatient services, the student is expected to work the
same hours as that of the supervising physician or clinic.
On the first day of clinic, the student should ask the preceptor or office manager to
provide an orientation to the clinic. This orientation should include fire and safety
protocol.
Each student will be assigned new patients for whom he or she is expected to perform a
complete evaluation.
The history and physical examination should be performed and recorded according to
the supervising physician and/or site expectation.
The initial work-up should include a detailed problem list, discussion of the differential
diagnosis, and initial management plan.
Review all pertinent physical examination, laboratory and diagnostic findings with the
supervising physician. Record these findings in the medical record.
The above information should be presented in an oral case presentation to the
supervising physician.
The student should collaborate with the supervising physician to construct or update a
problem list for each of their patients.
All notes must be dated, timed and signed by the student.
All notes must be countersigned by the supervising physician.
The student has a unique opportunity to impact the emotional well being of the patient.
Addressing non-medical aspects of patient care are essential.
Students should be aware of social services available within the community.
If the preceptor is taking call, the student is expected to take call as well. The
expectation is that the student should take call at least one night per week.
The student is responsible for asking the supervising physician for oral and written
feedback regarding his/her progress at mid-rotation.
Students should attend all educational conferences, meetings, and lectures offered at
the clinical site.
Students should promote the use of support groups and other community resources in
the area of mental health.
Students should recognize cultural and socioeconomic differences in patients/families
that may influences perceptions of wellness, disease, and treatment modalities.
Students should adhere to programmatic standards of professional interactions
between patients, families, staff and other members of the health care team.
The student is responsible for reading medical literature/textbooks regarding the
objectives and diagnoses listed in this syllabus. Furthermore, the student is responsible
for making oral presentations to the supervising physician and asking pertinent
questions regarding these objectives on a regular basis.
The student is responsible for maintaining a patient log inTyphon Group, to include data
(at a minimum) of: rotation type, rotation site, preceptor, date, age, gender, diagnoses
(ICD-9 codes) and procedures (CPT codes).
70
ROTATION OBJECTIVES:
I. MEDICAL KNOWLEDGE
A.
At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and provide the rationale needed to diagnose and treat
diseases seen in the primary care setting. The student will be able:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
July 2015
Cardiology
Hypertension
Hyperlipidemia
Myocardial Infarction (MI)
Cardiac Arrhythmia
Cardiac Murmurs
Deep Venous Thrombosis
CAD/Ischemic Heart Disease
Heart Failure
Carditis/ACS
Cardiomyopathy
Aneurysm
Aortic dissection
Congenital Heart Disease
Respiratory
Upper Respiratory Tract Infection
Lower Respiratory Tract Infection
Asthma/Bronchiolitis
COPD
Bronchitis/Pneumonia
Influenza/Pertussis
Pneumothorax
Pleural effusion/Pleuritis
Tuberculosis
Pulmonary embolism
Hemothorax
Sleep Apnea
Dermatology
Acneiform Conditions
Seborrhea
Warts/Skin Wounds
Gastrointestinal
Hepatitis/Pancreatitis
IBS/Diverticulitis
IBD
71
Gastritis, PUD
Gallbladder disease
Parasitic Infections
GERD
Diarrhea,Vomiting, Constipation
Esophageal Disorders
GI Carcinomas
Small/Large Intestine Disease
Nutritional Deficiencies
Liver Diseases
Endocrinology
DM Types 1 and 2
Thyroid/Parathyroid Disease
Galactorrhea
Thyroid cancer
Cushing's disease
Addison's disease,
Hyper/Hypoglycemia
Diabetes Insipidus
Heme/Onc
Anemias
Breast Cancer/Cervical Cancer
Coagulation Disorders
Platelet Disorders
Leukemia
Lymphoma
Myeloma
Sarcoma
Gynecological/Genitourinary
Menopause/Osteoporosis
Contraceptives
Breast Disease
Vaginitis
Cervical abnormalities
PMS, PMDD
Postmenopausal problems
Dysmenorrhea
AUB
Ectopic pregnancy
STIs/UTI
Epididymitis/Hydrocele
Prostate Cancer
Benign Prostatic Hypertrophy
Prostatitis/Fournier gangrene
Erectile Dysfunction
Testicular Cancer/Torsion
Balantitis/Orchitis
Penile Disorders
Scrotal Abnormalities
STIs, NGU
Ureteral Abnormalities
Hyperlipidemia
Behavioral Health
Depressive Disorders
Bipolar Disorder
GAD
PTSD, OCD
ADHD, ADD
Schizophrenia Disorders
Drug Abuse, Eating DO
Somatoform DO
Psychotherapy
July 2015
Lung Cancer
Geriatric Medicine
Functional Assessment of Elderly
Polypharmacy and Drug Reactions
Falls and Prevention
Urinary Incontinence
Conduct DO/Oppositional Defiant
Pressure Ulcers
Constipation
Pneumonia/Common Infections
Polymyalgia Rheumatica/TA
HTN, CVA
Delerium, Dementia, Depression
Adult Immunizations
Elder Abuse
72
Neuromuscular
Multiple Sclerosis
Fibromyalgia
Chronic Fatigue Syndrome
Rheumatoid Arthritis
Osteoarthritis
Acute Gout and Pseudogout (CPPD)
Headache
dizziness
Parkinsons Disease
Low Back Pain
Common Sports Injuries
Family Health
Meninigitis
SAH
Septic arthritis
Acute compartment syndrome
Fractures
Neck & Shoulder Pain
Ankle & Knee Pain
Communication
Palliative and End-of-Life Care
How to Break Bad News
Cultural competence
Ethical Decision making
Integrative Medicine
ENT
Otitis media/externa/serous
Sinusitis
Laryngeal disorders
Vocal disorders
Menieres disease
Vertigo, Labyrinthitis/Orthostatic
URI, Pharyngitis, Tonsillitis
Eye Abnormalities
Clinical Prevention
Team Care
Family Influences - Health & Dz.
Managing Multiple Morbidities
Diet, Exercise, Obesity
Clinical Decision Making
Tobacco and Alcohol Dependency
Domestic Violence
Physician-Patient Relationship
July 2015
HRT/ERT
Antihypertensives
Contraceptives
Antidiabetic medications including insulin
Cialis, Viagra
Anticoagulants
Ophthalmic drugs
Corticosteroids
HMG Co-A reductase inhibitors
Narcotics (e.g., hydrocodone)
Antidepressants
Anti-anxiety
Mood stabilizers
73
II. SKILLS
A.
By the completion of this rotation it is expected that the Physician Assistant student
will be able to competently demonstrate, elicit, formulate, interpret, synthesize,
perform, and document the following general patient management skills:
1.
2.
3.
4.
5.
6.
7.
Musculoskeletal injections
Drain subungual hematomas
Cryotherapy
Remove corn/calluses/warts
I&Ds
Skin staples
Suturing
Laceration repair with glues
Toenail and foreign body removal
Biopsies, etc.
Wet mount, KOH
Colposcopy
Digital rectal exam
Vasectomy
Bladder catheterization
Holter monitoring
July 2015
Pap smear
Cosmetic procedures (Botox, )
Bartholin cyst management
ACLS
Eye procedures (fluorescein exam, foreign
body removal, slit lamp)
Anterior nasal packing for epistaxis
Lumbar puncture
FNA
Basic ultrasonic procedures
U/LE splints
Joint Aspirations
Initial management of simple fractures
Closed reduction
Newborn circumcision
74
Spirometry
EKGs
X-ray studies including:
a. Flat and upright abdomen x-ray
b. Sonograms
Laboratory tests including, but not limited to:
a. CBC with differential
b. Chemistry panel
c. Coagulation panel
d. Liver function tests
e. Thyroid panel
f. CSF studies
g. Urinalysis with microscopic
h. Urine C & S
i. Pulmonary function tests
j. Fungal studies (KOH)
D. Patient education
1. Formulate patient education for hospitalized patients regarding their specific conditions,
treatment plans, and measures to maintain their health.
2. Anticipate and provide clear discharge planning and follow-up care instructions
III. PROFESSIONAL AND ETHICAL BEHAVIORS AND SKILLS
A. The Physician Assistant student will exhibit the following professional and ethical behaviors:
1.
2.
3.
4.
5.
6.
7.
B. The Physician Assistant student will demonstrate the following professional attitudes:
1. Consideration of the emotional and social backgrounds of patients and their families
2. Commitment to caring for all patients regardless of gender, race, socioeconomic status,
intellect, sexual orientation, or ability to pay
3. Willingness to ask for help from healthcare staff when appropriate and to utilize ancillary
resources
4. Openness to recognize limitations by using resource referrals and consultation with
July 2015
75
5.
6.
7.
8.
9.
Apply the principles of cost-effective health care and risk-benefit analysis in patient and/or
population care.
Demonstrate an understanding of the role of different specialists and other members of the
health care team in patient-centered care.
Work effectively in interprofessional teams to enhance patient safety and improve quality of
patient care.
July 2015
76
77
5.
6.
7.
8.
9.
Students should anticipate spending several hours per week reviewing pertinent anatomy, disease
processes, biomedical, clinical, epidemiological and social-behavioral sciences and their application
to the care of the surgical patient. Students should refer to required readings and conduct
independent research (e.g. surgical videos) to obtain knowledge concerning objectives/cases that
were not observed during the rotation.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all learning
objectives stated below:
COURSE GOALS: The goal of PA 580 is to provide practical experience to students in the field of
surgery that will foster translation and application of knowledge gained in the didactic curriculum to
the care of surgical patients in the hospital setting. The essential knowledge gained from the
preclinical courses to be applied in the surgical rotation includes:
1. Clinical manifestations of the most common emergent, urgent, and elective medical
conditions requiring surgical management.
2. Basic anatomical structures and their neurovascular relationships relevant to common
surgically managed diseases.
3. Physiological principles of fluid and electrolyte balance, their management and replacement.
4. Principles of hemodynamic monitoring.
5. Hemodynamic and hematological principles associated with blood loss, replacement, and
cardiac function.
6. Normal renal anatomy and physiology, action of diuretics, hormonal responses in salt and
water metabolism.
7. Indications for and limitations of essential diagnostic studies used to evaluate the surgical
patient.
8. Principles of common pharmacologic treatment (e.g., analgesics, antibiotics, anticoagulants,
sedatives) related to surgical patient management.
By the end of this course, the student will:
1. Demonstrate knowledge and understanding of common surgical problems.
2. Elicit a complete and accurately focused surgical patient history including belief systems,
spiritual and cultural issues and incorporate these into the comprehensive care of a surgical
patient.
July 2015
78
3. Select appropriate physical examination techniques, laboratory tests, radiologic, and other
clinical studies based on a presenting history and physical examination, and interpret the
results in the surgical patient.
4. Formulate appropriate differential diagnoses for the surgical patient based on presenting
history, physical examination, and investigative studies.
5. Synthesize and present a coherent description of the patient's clinical condition based upon
the information obtained from the patient and other resources.
6. Differentiate the surgical presentation of common disease processes, and plan and manage
their appropriate pre-operative work-up, intra-operative and post-operative care.
7. Become familiar with various surgical procedures, expected outcomes and complications.
8. Become familiar with alternatives to surgical treatment.
9. Create and maintain clear and accurate patient record documentation over the course of
the patients illness.
10. Competently perform basic procedures and technical skills utilized in the care of the surgical
patient.
11. Demonstrate clear and accurate patient education incorporating an appreciation for cost,
benefit and risk.
12. Consistently model appropriate professional and ethical behaviors and skills required of
Physician Assistants in the surgical environment.
GENERAL SURGERY ROTATION COURSE GRADE:
Preceptor evaluation 30% of grade
Multiple-choice General Surgery examination 30% of grade
Computer based Typhon Group patient tracking 15% of grade
Clinical Coordinator Evaluation 15 % of grade
Mid-rotation evaluation by preceptor 10 % of grade
July 2015
79
4. Surgery is a team-oriented specialty. Students should keep the team informed about any clinical
information relating to their patient(s).
OUTPATIENT SURGERY CLINIC:
1. When the opportunity is available to utilize outpatient services, the student is expected to work
the same hours as that of the supervising physician or clinic.
2. On the first day of clinic, the student should ask the preceptor or office manager to provide an
orientation to the office. This orientation should include fire and safety protocol.
3. The student is responsible for asking the supervising physician for feedback regarding his/her
progress midway through the rotation.
4. The student is responsible for reading medical literature/textbooks regarding the objectives and
diagnoses listed in this syllabus. Furthermore, the student is responsible for making oral
presentations to the supervising physician and asking pertinent questions regarding these
objectives on a regular basis.
July 2015
80
ROTATION OBJECTIVES
I. MEDICAL KNOWLEDGE
A. At the successful completion of the surgery rotation, the Physician Assistant student will be able
to explain and/or provide the rationale for the following aspects of commonly seen surgically
managed diseases and trauma listed below:
1. Anatomy
2. Pathophysiology
3. Etiology, incidence, and risk factors
4. Commonly associated symptoms
5. Clinical presentation including patient complaints/symptoms and physical examination
signs/findings
6. Diagnosis and differential diagnosis
7. Laboratory and radiographic studies: Provide the rationale for the appropriate ordering, use
and interpretation of diagnostic tests.
8. Indication and contraindication for surgical intervention
9. Preoperative and post operative patient management
10. Action, dosage and use of common pharmacologic agents used in surgery such as
analgesics, antibiotics, anticoagulants, and sedatives
11. Adjuvant therapies (indications and outcome)
12. Surgical Complications (recognition and treatment)
13. Prognosis
14. Elements of wound healing, homeostasis, shock and circulatory physiology and surgical
nutrition
15. Discharge (timing, patient education, follow-up, resumption of activities)
COMMONLY SEEN SURGICALLY MANAGED DISEASES
CARDIOVASCULAR
Aortic aneurysm/dissection
Arterial embolism/thrombosis
Chronic/acute arterial occlusion
Peripheral vascular disease
Lymphatic disease
Venous varicosities, phlebitis, thrombosis
Carotid artery occlusion
Cardiac tamponade
Pericardial effusion
BREAST
Abscess
Carcinoma
Fibroadenoma
Fibrocystic disease
Mastitis
PULMONARY
July 2015
Neoplastic Disease:
Bronchogenic carcinoma
Carcinoid tumors
Metastatic tumors
Pulmonary nodules
Mesothelioma
Pleural effusion
Pneumothorax (Primary, Secondary,
Traumatic, Tension)
ENDOCRINE
Thyroiditis
Thyroid neoplasia
Thyroid nodules
Pheochromocytoma
Adrenal neoplasia
GASTROINTESTINAL
Esophageal Diseases
81
Mallory-Weiss tear
Strictures & Obstruction
GastroesophagealVarices
GERD
Stomach
Upper GI Bleeding
Gastritis & Peptic Ulcer Disease
Gastric Neoplasms
Pyloric stenosis
Gastric bypass
Small Intestine, Colorectal and Anal
Appendicitis
Meckels diverticulosis/diverticulitis
Diverticular disease
Inflammatory bowel disease (CrohnsDz,
Ulcerative Colitis)
Ischemic bowel disease
Intussusception
Small and large bowel obstruction
Volvulus
Incarcerated bowel
Anal fissure
Anorectal abscess/fistula
Hemorrhoids
Colorectal Neoplasms
Pilonidal disease
Polyps
Lower GI Bleeding
Liver, Billiary and Pancreatic Diseases
Cirrhosis
Hepatic neoplasms
Acute/chronic cholecystitis
Cholelithiasis
Acute cholangitis
Acute/chronic pancreatitis
Pancreatic neoplasms
Pancreatic abscess
Pancreatic pseudocyst
Hernias
Esophageal/hiatal
Umbilical
Ventral
Inguinal
Femoral
July 2015
Incisional
Incarcerated bowel
GENITOURINARY
Neoplasms:
Bladder carcinoma
Prostate carcinoma
Renal cell carcinoma
Testicular carcinoma
Wilms' tumor
Benign prostatic hyperplasia
Incontinence
Nephro/urolithiasis
Testicular torsion
Ureter/Urologic trauma
DERMATOLOGIC
Neoplasms:
Basal cell carcinoma
Melanoma
Squamous cell carcinoma
Wounds
Decubitus ulcers/leg ulcers
Hidradenitissuppurativa
Lipomas/epithelial inclusion cysts
Burns
TRAUMA
Splenic rupture
Head Injury
Subdural hematoma
Epidural hematoma
Amputation
MUSCULOSKELETAL
Disorders of the Back & Spine
Caudaequina syndrome
Herniated nucleus pulposus
Disorders of the Upper Extremities
Fractures/dislocations
Rotator cuff disorders
Disorders of the Lower Extremities
Aseptic necrosis
Fractures/dislocations
Meniscal injuries of the knee
82
Osteoarthritis
Rheumatoid arthritis
Ileus
Fever
Diarrhea
Post operative pain
Hypertension
Fluid, Electrolyte and Acid/Base
Disorders
a. Hypo/hypernatremia
b. Hypo/hyperkalemia
c. Hypo/hypercalcemia
d. Hypo/hypermagnesemia
e. Metabolic alkalosis/acidosis
f. Respiratory alkalosis/acidosis
g. Volume depletion
h. Volume excess
7. Urinary retention
8. Acute renal failure
9. Shock (hypovolemic, cardiogenic,
neurogenic, septic)
10. Bleeding and Blood Replacement
11. Infections including:
a. Surgical site infections
b. UTIs
c. Nosocomial infections
d. Abscess formation
e. Pneumonia
f. Systemic Inflammatory
Response Syndrome (SIRS),
Sepsis, Septic Shock, Severe
Septic Shock
12. Phlebitis, DVT, pulmonary embolus
13. Fistula formation, sinus tract formation
14. Atelectasis, pneumonia, acute
respiratory distress syndrome (ARDS)
15. Chest pain, CHF, arrhythmias, MI
16. Delirium, seizures
17. Drug & transfusion reactions including:
a. Febrile reaction
July 2015
Infectious Diseases
Acute/chronic osteomyelitis
Septic arthritis
b. Acute hemolytic reaction
c. Desquamation
d. Stevens-Johnson syndrome
e. Toxic epidermal necrolysis
f. Erythema multiforme
18. Compartment syndrome
C. The student will be able to explain and
provide appropriate rationale for the
preoperative evaluation and operative and
post operative management/requirements
of the surgical patient with the following
comorbid disease processes:
1.
2.
3.
4.
5.
Adrenal insufficiency
Diabetes
Renal Failure
Pulmonary diseases: asthma, COPD
Cardiovascular diseases: CHF, MI,
hypertension, Valvular disease (AS,
MVP), arrhythmias (a-fib)
6. G6PD deficiency
7. Coagulation Disorders and
thrombocytopenia
83
e.
f. healing: primary, secondary,
tertiary intention
g. stages of wound healing
h. factors affect wound healing
process
i. classification of surgical wounds
5. Metabolism and nutrition including:
a. Nutritional assessment
b. Feeding options and solutions
c. Calculations for enteral and
parenteral alimentation
6. Fluid and electrolyte balance and
appropriate selection of
intravenous solutions including:
a. Dextrose 5% in water
b. Dextrose 5% and sodium chloride
0,45%
c. Sodium chloride 0.9%
d. Sodium chloride 0.45%
e. Lactated Ringers solution
7. Hemostatic mechanisms, surgical
bleeding and transfusion therapy
including indications, adverse
reactions, and medical management
of reactions associated with the
following blood products:
a. Platelets
b. Red blood cells
c. Fresh frozen plasma
d. Cryoprecipitate
E. The student will be able to discuss, explain
and provide rationale for the indications,
contraindications, mechanisms of action,
side effects and adverse reactions for the
following pharmacologic agents used for
the management of the surgical patient:
1.. Analgesics: morphine sulfate,
hydromorphone (Dilaudid), oxycodone
(Percocet, Oxycontin), hydrocodone
(Vicodin), tramadol (Ultram), ketorolac,
acetaminophen
2. Antacids, acid pump inhibitors, H2
blockers: omeprazole (Prilosec),
pantoprazole (Protonix), lansoprazole
(Prevacid)
July 2015
3.
OR patient positioning,
prepping and draping
Surgical wound
dressing/changes
Thoracentesis
Paracentesis
CPR
2. Describe the indications,
interpretation, and limitations of the
following diagnostic tests:
Coagulation panel
Amylase, lipase
Electrolytes
Chest X-ray
Urethrogram
IVP
V.Q. Scan
Ultrasound: abdominal,
echocardiogram and vascular studies
MRI
Bone scan
Mammogram
Nuclear tests
C. Demonstrate the ability to provide clear
and accurate surgical patient education:
85
1. Discharge instructions
2. Education about their specific
conditions and ways to maintain their
health.
3. Education regarding their legal rights,
including.
Informed consent
Right to refuse care
Transfusion consent
Surrogate decision makers
Treatment options and
alternatives
Risk Management
Advanced directives and how
they relate to surgery
HIPPA and Confidentiality
III. PROFESSIONAL AND ETHICAL BEHAVIORS
AND SKILLS
A. The Physician Assistant student will exhibit
the following professional and ethical
behaviors:
1. Follow all HIPPA and confidentiality
rules.
2. Document patient information
accurately and honestly.
3. Identify errors, assume responsibility
and correct any errors in an
appropriate manner.
4. Treat all patients and members of the
health care team with respect.
5. Display professionalism at all times
when working with other members of
the health care team.
6. Show responsibility at all times in
areas of attendance, demeanor, and
dress.
7. Display a willingness to help any
member of the team until the task is
completed (duty).
8. Arrive prepared for all patient duties
and cases.
9. Demonstrate evidence of self-directed
learning, problem solving and
appropriate clinical judgment.
July 2015
July 2015
87
GRADUATE BULLITEN COURSE DESCRIPTION: The student is assigned to hospital inpatient and outpatient ambulatory care settings in order to gain exposure to all reams of the womens health
across the life span. These experiences are to include: pre-natal, post-natal, pre-operative, intraoperative, post-operative care, annual wellness exam, and emergent care exams. Furthermore,
students are expected to further develop patient care skills through: the medical interview, history
and physical examination, critical thinking, enhancement of medical knowledge, patient and family
counseling, and understanding the role of a PA within the hospital team.
ROTATION DESCRIPTION: The Obstetrics and Gynecology rotation is a 4-week rotation, designed to
provide the student with an interactive, problem-based learning opportunity in the diagnosis and
management of common obstetric and gynecologic conditions, as well as, health care maintenance
and disease prevention for women. Students will acquire clinical experience through evaluation and
management of general Obstetrics and Gynecology patients under direct supervision by attending
physicians and PAs in both inpatient, surgical and outpatient settings. The team approach to
patient care and safety is emphasized while students participate in the work-up, diagnosis,
treatment and education of the obstetrical and gynecological patient and their family.
COURSE OVERVIEW: While under the supervision of the preceptor, students will work
independently to evaluate patients and formulate potential treatment plans, present the
assessment and plan for discussion, and participate in the required patient management activities
and clinical procedures. By the conclusion of the rotation, the student will demonstrate
competence in the basic clinical knowledge and skills needed to manage common diseases
encountered in the obstetrical and gynecological patient. While on this rotation the student is
expected to:
1.
2.
3.
4.
5.
6.
7.
July 2015
8.
9.
10.
11.
techniques.
Participate in patient education and health maintenance informatics.
Develop and execute discharge planning, discharge summaries, follow-up and
referrals.
Attend hospital conferences, lectures and all patient- care team meetings.
Assume overnight call as assigned by the preceptor but not more often than once
every third night.
Students should anticipate spending several hours per week reviewing pertinent female anatomy,
common disease processes in womens health, clinical practice guidelines, evidence-based
medicine, and treatments for the inpatient vs. outpatient obstetrics and gynecology patient.
Additionally, students should refer to suggested readings and conduct self-directed, independent
learning to obtain knowledge concerning objectives/cases which were not observed during the
rotation.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all learning
objectives stated below.
COURSE GOALS: The goal of PA 590 is to provide practical experience in the discipline of Obstetrics
and Gynecology that will foster translation of knowledge gained in the didactic curriculum, to the
care of the obstetrical and gynecological patients in the hospital and outpatient settings. The
essential knowledge gained from the preclinical courses to be applied in the Obstetrics and
Gynecology rotation includes:
1. Clinical manifestations of the most common acute, chronic, emergent, urgent, medical
conditions requiring obstetrics and gynecology management.
2. Basic anatomical structures and their relationships relevant to common medically managed
obstetrics and gynecology diseases.
3. Normal vs. abnormal pelvic examination.
4. Principles of hemodynamic monitoring.
5. Hemodynamic and hematological principles associated with blood loss, replacement, and
the obstetric and gynecologic patient.
6. Normal renal anatomy and physiology, action of diuretics, hormonal responses in salt and
water metabolism.
7. Normal endocrine function related to the Obstetrics and Gynecology patient.
8. Obstetric and gynecologic pathophysiology related to the diagnosis and treatment of
common disorders encountered in these patients.
9. Principles of pharmacologic and non pharmacologic treatment related to the obstetric and
gynecologic patient.
By the end of this course, the student will:
1.
2.
Elicit a complete and accurate patient history across all age groups, including belief
systems, spiritual and cultural issues and incorporate these into the comprehensive care of
an obstetrics and gynecology patient.
Select appropriate physical examination techniques with respect to age and identify
abnormalities relevant to the obstetric and gynecologic patient.
July 2015
89
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Address issues of patient modesty and comfort during the physical examination and/or
procedures.
Select appropriate laboratory tests, radiologic, and other clinical studies relevant to the
obstetric and gynecologic patient based on a presenting history and physical examination,
and interpret the results.
Formulate appropriate diagnosis and differential diagnoses for the obstetrics and
gynecology patient based on presenting history, physical examination, and investigative
studies using critical thinking skills.
Synthesize and present a coherent description of the patient's clinical condition to the
preceptor or his/her PA designee based upon the information obtained from the patient and
other resources.
Differentiate the medical presentation of common obstetric and gynecologic disease
processes.
Recognize risk factors and aspects of high-risk pregnancy.
Plan and manage appropriate pre-admission work-up, hospital stay, and post-hospitalization
care based on effectiveness, costs, risks-benefits, and patients overall goals and values.
Create and maintain legible, clear and accurate patient record documentation over the
course of the patients illness.
Competently perform basic procedures and technical skills utilized in the care of the
obstetrics and gynecology patient.
Demonstrate clear and accurate patient education, shared decision making, promotion of
health and health maintenance across a womens lifetime.
Demonstrate knowledge of the indications, contra-indications, usage and complications of
various methods of contraception.
Demonstrate knowledge of published guidelines regarding health maintenance and
prevention in womens health care.
Consistently model appropriate professional and ethical behaviors and skills required of
Physician Assistants in the inpatient/outpatient environment.
Preceptor evaluations will be determined by USA physicians in a team-based approach. They will
utilize the USA OB/Gyn Clerkship Clinical Passport to assist in compiling information (including
competencies) for student evaluations
July 2015
90
91
5. The student is responsible for reading medical literature/textbooks regarding the objectives and
diagnoses listed in this syllabus. Furthermore, the student is responsible for making oral
presentations to the supervising physician and asking pertinent questions regarding these objectives
on a regular basis.
ROTATION OBJECTIVES:
I. Medical Knowledge
A. At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and provide the rationale needed to diagnose and treat diseases
seen in the obstetrics and gynecology discipline in the hospital and clinic settings. The student
will be able to discuss the following aspects:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Pertinent anatomy
Definition and overview
Etiology
Epidemiology
Pathogenesis and pathophysiology
Clinical presentation
Diagnosis: provide explanation and rationale as to how the diagnosis and differential
diagnosis was formulated
Management: exhibit and explain the appropriate use and interpretation of diagnostic
test, medications, and other medical interventions
Complications of the disease diagnosed, medical treatments, and comorbid disease
states
Prognosis including the outcomes of treatment versus no treatment versus watchful
waiting
Life cycle stage and management planning in patient care.
Patient education, discharge planning, referral and follow-up
Primary, secondary and tertiary prevention
July 2015
Contraception
Abnormal uterine bleeding
Amenorrhea
Dysmenorrhea
Dyspareunia
Endometriosis
Polycystic ovarian disease
Breast disease
Breast cancer
Ovarian cancer
Uterine cancer
Endometrial cancer
Vaginitis
Sexually transmitted infections
Pelvic inflammatory disease
Infertility
Diagnosing pregnancy
Ectopic pregnancy
Prenatal care
Normal labor & delivery
Complications of pregnancy
Pre-eclampsia, eclampsia
High risk OB patients
Third trimester bleeding
92
Gestational diabetes
Menopause
Uncomplicated cystitis
Urinary incontinence
Annual screening
Pap smears
Breast exam
Additional Screening Tests
July 2015
93
B.
Explain the indications, contraindications, mechanism of action, side effects, interactions and
adverse reactions for the following pharmacologic and non-pharmacologic agents.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
II. Skills
Oral contraceptives
Combined estrogen and progestin
Combination, biphasic, triphasic
Progestin only
Emergency
Other forms of contraception
Barrier methods
Surgical methods
Rhythm method
Hormone replacement therapy
SERMs
NSAIDs used to treat premenstrual syndrome and dysmenorrhea
Osteoporosis agents
Menorrhagic agents
Endometriosis
Infertility agents
Treatments for Candidiasis
Treatments for Bacterial Vaginosis
Antivirals
Antibiotics to treat STIs
Prenatal care
Tocolytics
A. By the completion of this rotation it is expected that the Physician Assistant student will be able
to competently demonstrate, perform, and document the following general patient management
skills:
1. Elicit appropriate historical information for the female patient across the life span.
2. Perform the appropriate physical exam for the female patient across the life span.
3. Select and interpret appropriate laboratory and radiologic diagnostic studies in the female
patient across the life span.
4. Formulate an appropriate diagnosis and differential diagnosis and treatment plan utilizing
data gathered in the history, physical examination and investigative studies
5. Synthesize and present a coherent description of a patient case including:
a) chief complaint, focused history and physical findings
b) results of pertinent laboratory studies and imaging modalities
c) a primary diagnosis and differential with a recommended and reasonable plan of
treatment.
B. Demonstrate and document in written or EMR format the following:
1. Appropriately focused admission history and physical examination
2. Admission orders
3. Brief and Full procedure notes
July 2015
94
July 2015
95
96
July 2015
97
INSTRUCTOR :
July 2015
98
student didactic sessions (e.g. resuscitation, wound care, toxicology, and pediatric emergencies).
The student will have the opportunity and responsibility to provide patient care under the direct
supervision of an EM resident, physician, or his or her PA designee.
Students should anticipate spending several hours per week developing the knowledge and skills to
provide a well-organized and thoughtful plan of care in an acute care setting, how to develop a
working differential diagnosis and how to appropriately narrow the diagnosis. Students will have the
opportunity to evaluate patients as well as formulate effective testing and treatment strategies.
Students are encouraged to actively participate in patient care and procedural skills as permitted.
While on this rotation the student is expected to:
1. Recognize and determine the presence of a life threatening condition. Cardinal complaints
such as chest pain, shortness of breath, abdominal pain, headache, and altered mental
status, etc. need to be systematically evaluated.
2. Determine what interventions are necessary to stabilize the patient (e.g., airway
management, hemodynamic stabilization, and arrhythmia management, etc.).
3. Recognize and identify other potential serious disorders (high potential morbidity) that are
consistent with the patients presentation.
4. Perform a directed patient history and perform a complete or focused physical examination.
5. Demonstrate the skills necessary to provide efficient and safe evaluation and management
of patients presenting to the ED with a wide spectrum of patient-declared emergencies.
6. Demonstrate knowledge of common medical and surgical emergencies including their
epidemiology, pathophysiology, clinical features, diagnosis and appropriate management.
7. Formulate an appropriate patient workup and treatment plan, to include hospitalization.
8. Determine which diagnostic tests are indicated early in the course of treatment.
9. Develop and demonstrate the ability to interpret emergency laboratory reports such as plain
film radiography, electrocardiograms and arterial blood gases.
10. Perform case presentations directly to the EM resident, physician or his/her PA designee.
11. Recognize a specific diagnosis in the ED setting may not be possible or necessary.
12. Follow patients from initial examination through discharge from the ED.
a) Follow sign in-sign-out policy and procedures.
b) Address proper outpatient follow-up (document pertinent discharge instructions,
pertinent test results or interventions, follow-up with PCP).
c) Seek formative feedback from preceptor(s) as needed or pre-determined between the
student and preceptor(s).
d) Demonstrate an ability to work and interact with patients, their families and other
members of the health care team in a professional, compassionate and efficient manner.
e) Develop by way of clinical exposure, an appreciation of the physical, psychiatric, social
and economic issues that impact appropriate patient treatment and disposition.
Students must demonstrate the clinical ability to make good economic use of available
hospital and community services.
f) Provide appropriate patient education regarding disease process, prevention and
treatment of diseases commonly seen in the emergency setting.
g) Explain Good Samaritan laws, duty to report laws, and Emergency Medical Treatment
and Active Labor Act.
Students should anticipate spending several hours per week reviewing assessment of
undifferentiated patients, disease processes, and treatments for the EM patient. Additionally, they
July 2015
99
should refer to suggested readings and conduct independent research to obtain knowledge
concerning objectives/cases which were not observed during the rotation.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all learning
objectives stated below.
COURSE GOALS: The goal of PA 591 is to allow the PA student to learn the principles of addressing
the undifferentiated emergency patient and acquire the skills to recognize truly ill patients who may
require further inpatient management from those who can be treated and discharged. Initially the
student will shadow the supervising preceptor and progress to independent patient work-up,
evaluation, and plan as deemed appropriate by the preceptor. Students will progress over time to
presenting the assessment and plan to the preceptor for discussion and feedback, and actively
participating in any required patient management activities and emergency procedures. The
student should prioritize obtaining knowledge of both acute care and ongoing primary care for both
the adult and pediatric patient. By the conclusion of the rotation, the student should feel
comfortable in the evaluation of patients that present with acute care complaints in the ED setting
and should be able to recognize the patient with a life-threatening illness.
Prerequisite knowledge includes:
1.
Current knowledge of the clinical manifestations of the most common routine, urgent and
emergent medical conditions seen in the ED setting.
2.
Current knowledge and application of methods used in the preservation of life during lifethreatening medical conditions such as cardiac and respiratory arrest, stroke, sepsis, status
epilepticus, poisonings and blunt or penetrating trauma.
3.
Ability to perform directed physical assessment skills.
4.
Knowledge of surface anatomy needed for safely performing invasive procedures for patient
diagnosis, treatment and/or monitoring.
July 2015
100
Objective Structured Clinical Examination (OSCE) on the last Thursday of the ER rotation from
8:45 a.m. to 11 a.m. in the clinical skills lab in the medical school the student will examine
standardized patients and then answer PANCE style questions to assess their knowledge of
Emergency Medicine. The disease processes and questions may include, but are not limited to, the
following:
EKG interpretation and diagnosis
X-ray interpretation and diagnosis
Laboratory evaluation and diagnosis
Interpretation of patient scenarios similar to the standardized patient presentation
Approach to the management of commonly seen ED patient complaints (e.g., chest
pain, SOB, abdominal pain, pediatric fever, trauma, vaginal bleeding, and orthopedic
injury)
The students basic interview skills will also be evaluated by the SP. Areas evaluated include, but
are not limited to, questioning skills, verbal facilitation, non-verbal facilitation, and empathy.
Please see page 126 for other rotation grading information.
July 2015
101
STUDENT EXPECTATIONS:
1. On the first day of the emergency medicine rotation, the student should ask the preceptor to
provide an orientation to the emergency department. This orientation should include fire
and safety protocol.
2. Each student will be assigned new patients upon admission for whom he or she is expected
to perform a complete evaluation.
a. The history and physical examination should be performed and recorded according to
the supervising physician and/or site expectation.
b. The initial work-up should include a detailed problem list, discussion of the
differential diagnosis, and initial management plan.
c. Review all pertinent physical examination, laboratory and diagnostic findings with the
supervising physician. Record these findings in the medical record.
d. The above information should be presented in an oral case presentation to the
supervising physician.
3. The student should collaborate with the supervising physician to construct or update a
problem list for each of their patients.
4. Daily progress notes on the students patients should be written using a problem-oriented
approach.
a. All notes must be legible, dated, timed and signed by the student.
b. All notes must be countersigned by the supervising physician.
c. Document complete history and physical examinations
d. Document any procedures, diagnostic tests with results
e. Document consultations, referrals
f. Document discharge instructions and plans for outpatient follow-up
5. The student has a unique opportunity to impact the emotional well being of the patient.
Addressing non-medical aspects of patient care are essential.
a. Students should be aware of consultation for social services in the hospital.
b. Students should be aware of social services available within the community.
c. Students should recognize cultural and socioeconomic differences in
patients/families that may influences perceptions of wellness, disease, and
treatment modalities.
d. Students should adhere to programmatic standards of professional interactions
between patients and facility staff.
6. Students should attend all educational conferences, meetings, and lectures offered at the
clinical site.
7. Students are expected to take call at least one night a week if it is available on their service.
8. The student is responsible for maintaining a patient log in Typhon Group, to include data (at
a minimum) of: rotation type, rotation site, preceptor, date, age, gender, diagnoses (ICD-9
codes) and procedures (CPT codes).
July 2015
102
ROTATION OBJECTIVES:
I. MEDICAL KNOWLEDGE
A.
At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and when appropriate provide the rationale needed to diagnose
and treat diseases seen in the Emergency Medicine discipline in the hospital and clinic
settings. The student will be able to discuss the following as they relate to patients
commonly seen in EM:
1.
2.
3.
4.
5.
Cardiovascular :
o Acute ischemic heart disease, including unstable angina, acute myocardial infarction,
and acute coronary syndrome In particular, this must include an ability to interpret
patterns of ischemia and infarction on EKG, an understanding of the utility of laboratory
investigation in the emergency diagnosis of CAD, an ability to interpret laboratory
findings and a working knowledge of the emergency management of acute infarction.
Acute congestive heart failure, including common precipitants, emergency management
and criteria used for determining disposition.
o Common cardiac dysrhythmias, including acute atrial fibrillation, paroxysmal atrial
tachycardia, complete heart block, ventricular fibrillation and ventricular tachycardia.
o Syncope
o Shock
o Cardiac tamponade
o Malignant hypertension
o Traumatic aortic rupture
o Chest pain
o Cardiac arrest
July 2015
103
Respiratory :
o Acute exacerbations of asthma and COPD, emphasizing emergency management and
the criteria used in determining disposition (including bedside spirometry).
o Community-acquired pneumonia
o Anaphylaxis and upper airway obstruction
o Spontaneous pneumothorax
o Deep venous thrombosis and pulmonary embolism.
o Pulmonary edema
o Hemoptysis
o Shortness of breath
Gastrointestinal:
o Acute upper and lower GI bleeding
o Liver, pancreas and appendix, to include biliary colic, cholecystitis, ascending cholangitis,
pancreatitis, appendicitis
o Obstruction, small vs. large bowel
o Acute diarrhea (differential diagnosis and infectious etiologies)
o Abdominal aortic aneurysm rupture
o Abdominal pain
Genitourinary :
o Upper and lower UTI, pyelonephritis
o Renal colic, including interpretation of intravenous urogram
o Testicular pain and/or swelling
o Sexually-transmitted infections and pelvic inflammatory disease
o Ectopic pregnancy
Endocrine:
o Hyper or hypoglycemia
o DKA
o Thyroiditis, Myxedema
o Adrenal crisis
Musculoskeletal :
o Minor extremity trauma, fractures and dislocations of digits, ankle sprains, minor ankle
fractures, soft tissue injuries of the knee, Colles fractures, boxer's fractures, radial head
fractures, shoulder dislocations, humeral neck fractures
o Acute monarticular arthritis, septic arthritis
July 2015
104
Infectious Disease:
o Abscesses
o Cellulitis
o Rickettsial disease, Lyme disease
o Disseminated gonococcus
o Influenza
o Pneumonia
o HIV/AIDS
o Wounds (bites)
o Sexually transmitted infections
Psychiatric:
o Substance abuse, ETOH abuse, drug overdose
o Illicit drug use
o GAD, Acute psychosis, schizophrenia
o Suicide, suicidal ideation, depression
Toxicology:
o Specific overdose management of salicylates, acetaminophen, Tricyclic antidepressants
and sedative hypnotics
o Poisoned or intoxicated patient
Neurology:
o Migraine headache and emergency treatment options
o Stroke and TIA
o New onset and previously diagnosed seizure disorders
o Meningitis
o Coma
o Epidural and subdural hematoma
o Depressed or altered level of consciousness/coma
o Syncope
o Altered mental status
o Traumatic brain injury
Environmental Emergencies:
o Hypo- and hyperthermia
o Electrical injury, thermal and chemical burns
o Smoke inhalation and CO intoxication
Pediatric Emergencies:
o Fever of unknown origin - approach by age group
o Pediatric asthma, croup and epiglottitis
o Vomiting, diarrhea and rehydration therapy
July 2015
105
Others:
o Multiple traumas (blunt force, vehicular, etc.)
o Domestic violence
o Elder abuse
o End of life issues
o New-onset headache
o Fever of unknown origin (various age groups)
o Domestic violence
o Vaginal bleeding - pregnant or non-pregnant patient
II. Skills
A. By the completion of this rotation it is expected that the Physician Assistant student will be able
to competently demonstrate, perform, and document the following general patient management
skills:
1. Elicit appropriate historical information for the presenting chief complaint.
2. Perform the appropriate physical exam for the presenting chief complaint
3. Select and provide appropriate rationale for ordering laboratory and radiologic diagnostic
studies
4. Formulate an appropriate differential diagnosis and treatment plan utilizing data gathered in
the history, physical examination and investigative studies
5. Synthesize and present a coherent description of a patient case including:
a. chief complaint, focused history and physical findings
b. results of pertinent laboratory studies and imaging modalities
c. diagnosis and differential with a recommended and reasonable plan of treatment.
d. Understand your limitations
B. Demonstrate and document in written or EMR format the following:
1.
2.
3.
4.
July 2015
Lumbar puncture
Suture simple lacerations
Casting/splinting, axial skeleton immobilization
Reduction of shoulder dislocation
Joint aspiration of knee and ankle
Operate slit lamp
Glasgow coma scale
Nasogastric tube, nasal/oral airway, nasal packing
Endotracheal intubation
I and D abscess
Removal of corneal foreign body
EKGs
X-ray studies including:
a. Plain chest and abdominal
b. Axial skeleton and extremities
c. Sonograms
d. CT/with and without contrast
e. MRIs
f. PET Scan
g. Nuclear Scan
h. CBC with and without differential
i. Chemistry panel
j. Coagulation panel
k. Liver function tests
l. Thyroid panel
m. Arterial blood gas
n. Serum electrolytes, including specific abnormalities such as
hyper/hypokalemia, hyper/hyponatremia and anion gap
o. Dipstick and Urinalysis with microscopic
p. D-dimer
q. B-Natriuretic protein, isoenzymes
r. HIV/AIDS profiles
July 2015
107
B. The Physician Assistant student will exhibit the following professional attitudes:
1. Sensitivity to the emotional and social backgrounds of patients and their families
2. Sensitivity in interaction with patients of different cultural backgrounds
3. Willingness to ask for help from healthcare staff when appropriate and to utilize ancillary
resources
4. Openness to recognize limitations by using resource referrals and consultation with
supervising preceptor when appropriate
5. Openness to receiving constructive criticism
6. General concern for patients by comprehensively monitoring their progress and
documenting thorough patient records
IV. PRACTICE-BASED LEARNING
The successful PA student will exhibit the ability to:
1. Continuously evaluate patient care practices, and appraise and assimilate scientific
evidence, in order to improve the practice of medicine and ensure the safety and quality of
patient care
2. Apply medical standards, clinical practice guidelines, and practice algorithms appropriately
for individual patients or populations.
3. Apply reflection and feedback to incorporate lessons learned into future practice
4. Critically appraise the effectiveness of diagnostic and therapeutic interventions
V. SYSTEMS-BASED PRACTICE
The successful PA student will:
1. Effectively interact with a variety of medical practices and delivery systems
2. Effectively use information technology to support patient care decisions and patient
education
3. Advocate for quality patient care and assist patients in dealing with healthcare system
complexities
July 2015
108
4. Partner with supervising physicians, healthcare managers and other healthcare providers to
assess, coordinate, and improve the delivery of health care and patient outcomes.
5. Apply the principles of cost-effective healthcare in patient care.
July 2015
109
C. Grading
Each station will have three questions with each question being worth one point.
Station I
___/3
Station II
___/3
Station III
___/3
Station IV
___/3
Station V
___/3
The score from the five quizzes will be averaged with the five interview skill scores.
July 2015
110
David Hood
Vanessa Hoppner
Tyler Johnson
Megan Jolley
Chasity Gibson
Alianna Gilmartin
Kelsey Harja
Satchel Harry
Cassandra Dufano
Chelsea Exum
Rebecca Falgout
Christina Gautier
Leah Ambrose
Benjamin Brock
Virginia Davis
Veronica Dawson
Daniel Yee
David Yorio
Chang Zou
Carolyn Waddell
Shelby White
Elizabeth Wilson
James Wymer
Stephen Smith
Max Tijerino
Kayla Travis
Amy Vu
Jamie Pilcher
Joshua Pyeatt
Nicole Richards
Maegan Roberts
Mallory Mullis
Christina Nakamoto
Jeanine North
Elissa Pelton
Daryl Lacey
Molly McCracken
Jonathan Meadows
Caitlin Mosley
July 2015
111
GRADUATE BULLITEN COURSE DESCRIPTION: The student will choose from a variety of available
elective rotations in order to engage in all aspects of patient care including: the medical interview,
history and physical exam, critical thinking, knowledge base, diagnosis and treatment plan, patient
education, appropriate health maintenance and disease prevention measures. The goal of elective
rotations is to provide the student the opportunity to explore areas of interest for further
employment or increase knowledge in areas of weakness.
ROTATION DESCRIPTION: Elective 1 rotation is a 4-week rotation, designed to provide the student
with an opportunity to gain more clinical knowledge and skills in a subspecialty or
outpatient/primary care medical setting. Students are encouraged to choose an elective based on
clinical areas of deficiency in which they need to improve or, increased exposure to a medical field
that is pertinent to the students career objective practice areas. They can chose from a list of
existing clinical sites or initiate a request for a new clinical site. All students are encouraged to
meet with the Clinical Coordinator and/or their faculty advisor to discuss their elective rotation
selection prior to the final decision. The team approach to patient care and safety is emphasized
while students participate in the work-up, diagnosis, treatment and education of the patient and
their family.
COURSE OVERVIEW: While under the supervision of the preceptor, students will assess and treat
patients in a variety of settings working independently to evaluate patients and formulate potential
treatment plans, present the assessment and plan for discussion, and participate in the required
patient management activities and clinical procedures. By the conclusion of the rotation, the
student will demonstrate competence in the basic clinical knowledge and skills needed to manage
common diseases encountered in the elective rotation. While on this rotation the student is
expected to:
1.
2.
2.
3.
4.
5.
6.
Students should anticipate spending several hours per week reviewing basic sciences,
epidemiology, pathophysiology, clinical presentation, diagnostics and treatment plans pertinent for
July 2015
112
patient care for the chosen elective. Additionally, students should refer to suggested readings and
conduct self-directed learning to obtain a breadth and depth of knowledge concerning
objectives/cases which were not observed during the rotation.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all learning
objectives stated below.
COURSE GOALS: The goal of PA 592 is to provide practical experience in the discipline specific to
their elective that will foster translation of knowledge gained in the didactic curriculum, to the care
of patients in various settings. The essential knowledge gained from the preclinical courses to be
applied in the rotation includes:
1. Clinical manifestations of the most common acute, chronic, emergent, urgent and medical
conditions requiring management across the lifespan of the patient (e.g., pediatrics,
adolescents, adults, elderly).
2. Basic physiology, anatomy, and infectious diseases and their relationships relevant to
common medically managed diseases.
3. Principles of pharmacologic and non-pharmacologic treatment related to medical patient
management.
By the end of this course, the student will:
1. Demonstrate analytical thinking, knowledge and application of basic sciences pertinent to
the medical setting.
2. Demonstrate a foundation of skills in interviewing, informed decision-making, and the
development of management plans for patient care.
3. Elicit a complete and accurately complete and/or focused patient history including belief
systems, spiritual and cultural issues and incorporate these into the comprehensive care of
the patient.
4. Select appropriate physical examination techniques, laboratory tests, radiologic, and other
clinical studies based on a presenting history and physical examination, and interpret the
results.
5. Formulate appropriate diagnosis and/or differential diagnoses for the patient based on
presenting history, physical examination, and investigative studies.
6. Develop appropriate medical treatment plan.
7. Synthesize and present a coherent description of the patient's clinical condition to the
preceptor or his/her PA designee based upon the information obtained from the patient and
other resources.
8. Differentiate the medical presentation of common disease processes, and plan and manage
their appropriate care.
9. Create and maintain clear and accurate patient record documentation over the course of
the patients illness.
10. Competently perform basic procedures and technical skills utilized in the care of the patient.
11. Demonstrate ability to counsel and deliver clear and accurate patient education.
12. Display appropriate professional and ethical behaviors and skills required of Physician
Assistants in the inpatient/outpatient environment.
13. Demonstrate respectful, altruistic, ethically sound practice that is sensitive to culture, age,
gender, SES, race/ethnicity, disability, education, poverty, etc.
July 2015
113
July 2015
114
Date:
Faculty:
Grade: __
/25
D. Purpose
a. Case-based learning (CBL) uses a guided inquiry method. The Center for Instructional
Development & Distance Education, retrieved 19:35, 11 October 2007 (MEST) defines CBL
as the following: Cases are factually based, complex problems written to stimulate
classroom discussion and collaborative analysis. Case teaching involves the interactive,
student- centered exploration of realistic and specific situations. As students consider
problems from a perspective which requires analysis, they strive to resolve questions .
E. Requirement
The Case-Based Learning (CBL) assignment will be presented on the last Thursday of the Elective
rotation from 1 p.m. to 3 p.m.
F. Grade 25 points
Criteria:
Appropriate selection of patient profile and organization of CBL assignment (5points)
the patient profile selected was appropriate for a case-based learning assignment.
The CBL was well organized to flow logically and contain all the necessary patient,
medical and assessment information as indicated.
Knowledge regarding CBL patient and diagnosis (5points): during the presentation,
the clinical student demonstrated knowledge and in depth understanding of the
patient's present illness, past medical history, diagnosis and treatment. Knowledge
was such that independent research had been conducted to conduct class
discussion.
Professional attire and presence (5points): the student was well prepared for the
CBL, including professional attire, demeanor, handling of sensitive cultural and
medical information, and overall presence during the presentation. The student
modeled professional behavior to the didactic students during the course of the CBL.
Demonstrated effective communication skills (5points): during the CBL the student
exhibited effective communication skills through verbal and nonverbal
communication with the class. Eye contact was maintained, voice inflection was
utilized when appropriate, proper usage of technical and/or classroom materials
were utilized. Engaged didactic student participation during the course of the CBL.
Ability to answer questions and maintain discussion (5points): the student was able
to utilize critical thinking skills during the CBL by answering questions and
maintaining classroom discussion.
July 2015
115
I. Medical Knowledge
A.
ROTATION OBJECTIVES:
At the completion of this rotation, the physician assistant student will successfully
demonstrate clinical skills and when appropriate provide the rationale needed to diagnose
and treat diseases seen in the discipline. The student will be able to discuss the following
aspects:
July 2015
116
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
B.
C.
II. Skills
A. By the completion of this rotation it is expected that the Physician Assistant student will be able
to competently demonstrate, perform, and document the following general patient management
skills:
1.
2.
3.
4.
July 2015
117
B. The Physician Assistant student will exhibit the following professional attitudes:
1. Sensitivity to the emotional and social backgrounds of patients and their families
2. Sensitivity in interaction with patients of different cultural backgrounds
3. Willingness to ask for help from healthcare staff when appropriate and to utilize ancillary
resources
4. Openness to recognize limitations by using resource referrals and consultation with
supervising preceptor when appropriate
5. Openness to receiving constructive criticism
6. General concern for patients by comprehensively monitoring their progress and
documenting thorough patient records
IV. PRACTICE-BASED LEARNING
The successful PA student will exhibit the ability to:
1. Continuously evaluate patient care practices, and appraise and assimilate evidence-based
scientific evidence, in order to improve the practice of medicine and ensure the safety and
quality of patient care.
2. Apply medical standards, clinical practice guidelines, and practice algorithms appropriately
for individual patients or populations.
3. Apply reflection and feedback to incorporate lessons learned into future practice.
4. Critically appraise the effectiveness of diagnostic and therapeutic interventions.
5. Incorporate the use of medical technology resources to increase medical knowledge and
clinical skills.
July 2015
118
V. SYSTEMS-BASED PRACTICE
The successful PA student will:
1. Effectively interact with a variety of medical practices and delivery systems.
2. Effectively use information technology to support patient care decisions and patient
education.
3. Advocate for quality patient care and assist patients in dealing with healthcare system
complexities.
4. Partner with supervising physicians, healthcare managers and other healthcare providers to
assess, coordinate, and improve the delivery of health care and patient outcomes.
5. Apply the principles of cost-effective health care in patient care.
July 2015
119
GRADUATE BULLITEN COURSE DESCRIPTION: The student will choose from a variety of available
elective rotations in order to engage in all aspects of patient care including: the medical interview,
history and physical exam, critical thinking, knowledge base, diagnosis and treatment plan, patient
education, appropriate health maintenance and disease prevention measures. The goal of elective
rotations is to provide the student the opportunity to explore areas of interest for further
employment or increase knowledge in areas of weakness.
ROTATION DESCRITION: The Elective 2 rotation is a 4-week rotation, designed to provide the
student with an opportunity to gain more clinical knowledge and skills in a subspecialty or
outpatient/primary care medical setting. This rotation is the last rotation prior to graduation.
Students are encouraged to choose an elective based on clinical areas of deficiency in which they
need to improve or, increased exposure to a medical field that is pertinent to the students career
objective practice area, or in an area with a potential employer(s). Students can chose from a list of
existing clinical sites or initiate a request for a new clinical site. All students are encouraged to
meet with the Clinical Coordinator and/or their faculty advisor to discuss their elective rotation
selection prior to the final decision. The team approach to patient care and safety is emphasized
while students participate in the work-up, diagnosis, treatment and education of the patient and
their family.
COURSE OVERVIEW: While under the supervision of the preceptor, students will assess and treat
patients in a variety of settings working independently to evaluate patients and formulate potential
treatment plans, present the assessment and plan for discussion, and participate in the required
patient management activities and clinical procedures. By the conclusion of the rotation, the
student will demonstrate competence in the basic clinical knowledge and skills needed to manage
common diseases encountered in the elective rotation. While on this rotation the student is
expected to:
1. Formulate a comprehensive and/or focused history.
2. Perform a comprehensive and/or focused physical exam.
3. Participate in daily patient assessment and medical management over the course of the
patients stay.
4. Participate as part of an interprofessional team providing patient-centered care.
5. Become skilled at and perform various medical/surgical procedures and techniques.
6. Participate in patient education, discharge planning and discharge summaries, where
appropriate.
7. Attend conferences, lectures and all patient- care team meetings.
July 2015
120
Students should anticipate spending several hours per week reviewing basic sciences, pertinent
anatomy, medical/surgical disease processes, and treatments plans pertinent for patent care for
the chosen elective. Additionally, they should refer to suggested readings and conduct selfdirecting learning to obtain a breadth and depth of knowledge concerning objectives, medico
surgical cases which were not observed during the rotation.
The student will report to the Physician Assistant Program for administrative meetings and
examinations at the end of the rotation. The end-of-rotation examination includes all learning
objectives stated below.
COURSE GOALS: The goal of PA 593 is to provide practical experience in the discipline specific to
their elective that will foster translation of knowledge gained in the didactic curriculum, to the care
of patients in various settings. The essential knowledge gained from the preclinical courses to be
applied in the rotation includes:
1. Clinical manifestations of the most common acute, chronic, emergent, urgent, medical or
surgical conditions requiring management across the lifespan of the patient (e.g., pediatrics,
adolescents, adults, elderly).
2. Basic physiology, pathophysiology, anatomy, and infectious diseases and their relationships
relevant to common medico surgically managed diseases.
3. Principles of pharmacologic and non-pharmacologic treatment related to medical patient
management.
By the end of this course, the student will:
1. Demonstrate analytical thinking, knowledge and application of basic sciences pertinent to
the medical setting.
2. Demonstrate a foundation of skills in interviewing, informed decision-making, and the
development of management plans for patient care in medico surgical patients.
3. Elicit a complete an accurately complete and/or focused patient history including belief
systems, spiritual and cultural issues and incorporate these into the comprehensive care of
the patient.
4. Select appropriate physical examination techniques, laboratory tests, radiologic, and other
clinical studies based on a presenting history and physical examination, and interpret the
results.
5. Formulate appropriate diagnosis and/or differential diagnoses for the patient based on
presenting history, physical examination, and investigative studies.
6. Develop appropriate treatment plan for medico surgical patient.
7. Demonstrate initial management of life threatening surgical illnesses and be adept at
resuscitation.
8. Demonstrate sound judgments, safety, and effectual technical skills in operative cases.
9. Synthesize and present a coherent description of the patient's clinical condition to the
preceptor or his/her PA designee based upon the information obtained from the patient and
other resources.
10. Differentiate the presentation of common medical and surgical disease processes, and plan
and manage their appropriate care.
11. Perform pre and post operative care of patients with the basic understanding of
pathophysiology as applied to surgical diseases.
12. Create and maintain clear and accurate patient record documentation over the course of
July 2015
121
July 2015
122
6. Students should attend all educational conferences, meetings, and lectures offered at the clinical
site.
7. Students are expected to take call at least one night a week if it is available for this elective.
8. The student is responsible for maintaining a patient log in Typhon Group, to include data (at a
minimum) of: rotation type, rotation site, preceptor, date, age, gender, diagnoses (ICD-9 codes) and
procedures (CPT codes).
9. The student is responsible for asking the supervising physician for feedback regarding his/her
progress midway through the rotation.
10. The student is responsible for reading medical literature/textbooks regarding the objectives and
diagnoses listed in this syllabus. Furthermore, the student is responsible for making oral
presentations to the supervising physician and asking pertinent questions regarding these objectives
on a regular basis.
ROTATION OBJECTIVES:
I. MEDICAL KNOWLEDGE
A.
At the completion of this rotation, the physician assistant student will successfully demonstrate
clinical skills and when appropriate provide the rationale needed to diagnose and treat
medical/surgical diseases seen in the discipline. The student will be able to discuss and
explain the following aspects:
1.
2.
3.
4.
5.
6.
7.
8.
Anatomy
Definition and overview
Etiology
Epidemiology
Pathogenesis and pathophysiology
Clinical presentation
Diagnostic evaluation: what/why/interpretation
Diagnosis: provide explanation and rationale as to how the differential diagnosis was
formulated
9. Management: exhibit and explain the appropriate use and interpretation of diagnostic test,
medications, and other medical interventions
10. Complications of the disease diagnosed, medical treatments, and comorbid disease states
11. Prognosis including the outcomes of treatment versus no treatment versus watchful
waiting
12. Patient education, referral and discharge planning
13. Primary, secondary and tertiary prevention
B.
Explain the indications, contraindications, mechanism of action, side effects, interactions and
adverse reactions for the commonly used pharmacologic agents.
July 2015
123
1.
2.
3.
4.
124
July 2015
125
100%
90%
80%
70%
60%
50%
For Internal Medicine, Psychiatry, Pediatrics, Primary Care, ER and Elective rotations you are
responsible for obtaining a hardcopy end of rotation evaluation and bringing it to your end of
rotation activity or exam.
Clinical Preceptor Evaluation
a.
Clinical preceptors will evaluate student performance based on day-to-day observation of the
students clinical work during the rotation. Specific evaluation criteria to be considered include:
1.
2.
3.
4.
5.
6.
b.
c.
d.
Clinical year students are expected to assume responsibility for their education while on
rotation. Part of this responsibility includes frequently seeking performance feedback from
clinical preceptors. At a minimum, students are required to elicit a mid-rotation evaluation to
provide to the Program Director as part of their grade. This will allow the student to review their
progress and plan strategies for correcting any identified deficiencies.
The end of the rotation is NOT an appropriate time for a student to find out that he/she has
not performed satisfactorily!
July 2015
126
Date of encounter
Period (rotation #)
Rotation type
Clinical site
Setting type
If surgery, whether or not the experience was pre-op, intra-op, or post-op
Preceptor
Patient age
Patient gender
Patient ethnicity
ICD 9 diagnosis code(s)
CPT procedure codes(s)
Patient tracking/logging is NOT optional. Many credentialing agencies (i.e. hosptials) require
student patient tracking logs for verification of adequate training to perform duties and
responsibilities as a physician assistant. At the discretion of the Student Progress
Committee, failure to properly submit patient tracking will result in the loss of points on the
end-of-rotation grade OR the need to repeat the rotation. In such cases, graduation can be
delayed by four to eight weeks depending on the length of the rotation.
If no data has been entered by the deadline, the student will receive a zero for this portion of
their grade and an Incomplete for the rotation. The entire rotation will be repeated at the
end of the clinical year. Failure to repeat the rotation and clear the Incomplete from their
transcript will cause the Registrar to record a grade of F, thereby resulting in Academic
Dismissal from the PA Program.
The student is responsible for all fees associated with purchasing access to Typhon Group.
Currently, a one-time fee of $80 per student is made payable directly to Typhon Group via
major credit cards. This cost is subject to change according to the fees negotiated between
the Typhon Group and USA.
July 2015
127
This evaluation is critical in providing the student with needed feedback on areas of
strengths and areas of needed improvement. Send to Natasha Edwards via email
(nedwards@southalabama.edu). It is the responsibility of the student to send the midrotation evaluation, not the responsibility of the preceptor. All students are required to
download CamScanner app on their smartphone to help facilitate this process. One point
will be deducted for each day the assignment is received after the midpoint of the rotation.
July 2015
128
July 2015
129
Mid-Rotation Evaluation
Student Name: __________________________ Date: ____________________
Rotation #______
Location:_______________________________________________
Performed
below
expected
level
Performed
at
expected
level
Above
average
Exceptional
1point
2points
3points
4points
5points
Medical Knowledge
(5=develop and justify an appropriate
differential and cohesive treatment plan)
Patient Care
(5=multi-tasks effectively; independent
decisions; excellent procedural skills)
Professionalism
(5=team player; strong work ethic;
professional towards patients)
Interpersonal & Communication
(5=communicates effectively to
patients; superior interactions with staff)
System Based Practice
(5=uses resources/consultants
effectively; appropriate patient f/u)
Comments:__________________________________________________________________________
Evaluator Name:
___________________________________________________________
Print Name
_______________________________________________________________________
Sign Name
July 2015
130
Curved Score
50
55
60
65
70
75
80
85
90
95
100
SCORE
90 -100
80 89
70 79
60 69
0 59
Only grades of B or above represent acceptable professional work for the Physician
Assistant student.
2.
Per Graduate School Policy, any term in which a graduate student drops below a 3.0
GPA, the student is placed on probationary status and has a period of two terms to
attain a 3.0 GPA or be academically dismissed by the Graduate School. Therefore, a
grade of C or lower on a clinical rotation may either result in dismissal from the PA
Program or academic probation, depending on academic record of the student. Only
two Cs can be applied towards graduation. Students must have a 3.0 to graduate
from the PA Program.
3.
4.
July 2015
131
REMEDIATION
The goal of the remediation policy of the Department of Physician Assistant Studies is
to remediate students who are not performing at the optimal level during the clinical
year, which is defined in three areas:
1.
2.
3.
All students who have not performed satisfactorily in meeting student learning
objectives by mid-rotation are required to be remediated by the PA Department in the
following manner prior to proceeding to the next clinical rotation:
1.
2.
3.
4.
5.
6.
7.
Meet with the Program Director and/or faculty advisor to discuss which student
learning objective(s) resulted in the student not meeting expected rotation
objectives
Meet with the clinical preceptor for feedback and assessment of student
performance thus far and identify areas that require additional work for the rest
of the rotation
Perform student self-evaluation about the learning experience, expectations and
rotation objectives
Review case presentation, documentation, assessments and plans
Review patient history-taking and physical examination skills
Review assigned case-based learning materials
Utilize referral services as appropriate (e.g., USA counseling & testing center,
primary care provider, USA Psychological Center)
e.
END OF ROTATION EXAMINATIONS: Exams are scheduled for the Friday following the rotation.
Laptop computers with internet access are required for all end-of-rotation examinations. Failure to
July 2015
132
be adequately prepared, and have appropriate equipment, will result in a zero for the exam grade.
Students are expected to take all exams at the scheduled times and be present before the
examination starts. The only excused absence from an exam is a valid medical excuse from a
physician or PA.
CHANGES IN COURSE REQUIREMENTS: Not all classes progress at the same rate thus course requirements
might have to be modified as circumstances dictate. You will be given written notice if the course
requirements need to be changed.
STUDENT CONDUCT & PROFESSIONALISM: The University of South Alabamas policy regarding
Academic Disruption is found in The Lowdown, the student handbook:
http://www.southalabama.edu/lowdown/academicdisruption.shtml
Disruptive academic behavior is defined as individual or group conduct that interrupts or interferes
with any educational activity or environment, infringes upon the rights and privileges of others,
results in or threatens the destruction of property and/or is otherwise prejudicial to the
maintenance of order in an academic environment. We expect students to be cordial, courteous
and respectful of faculty members, preceptors, patients and fellow students.
Students must follow all the rules, regulations and policies as outlined in the Student Handbook of
the University of South Alabama, the Student Handbook for the Department of Physician Assistant
Studies, and all other University policies with respect to their conduct. The highest standards of
honesty and integrity are expected. Students who cheat on assignments during this course will be
referred to the Student Progress Committee and the Department Student Progress Committee for
possible dismissal from the Program. Our students are expected to display altruism, accountability,
excellence, duty, honor, integrity and respect for others. Unprofessional behavior will not be
tolerated.
STUDENT ACADEMIC CONDUCT POLICY: The University of South Alabamas policy regarding Student
Academic Conduct Policy is found in The Lowdown
http://www.southalabama.edu/lowdown/academicconductpolicy.shtml:
The University of South Alabama is a community of scholars in which the ideals of freedom of
inquiry, freedom of thought, freedom of expression, and freedom of the individual are sustained.
The University is committed to supporting the exercise of any right guaranteed to individuals by the
Constitution and the Code of Alabama and to educating students relative to their responsibilities.
ONLINE WRITING SUPPORT: The University of South Alabama provides online writing tutoring
services through SMARTHINKING, an online tutoring service. SMARTHINKING is available at
http://services.smarthinking.com.
ATTIRE: Students are expected to wear a short white lab coat with the USA PA Program patch on
the pocket and a University of South Alabama Physician Assistant identification badge at all times.
Scrubs or appropriate clinic attire are site specific and should be identified after the first day of the
rotation. Closed toe shoes must be worn in all clinic settings in accordance with the occupational
safety requirements. Avoid the use of scented products to include items such as hair spray,
perfume, or colognes. Students are to dress professionally and appropriately for a clinical and/or
patient care setting at all times.
July 2015
133
WITHDRAWAL: Withdrawal from any individual course in the physician assistant curriculum will
result in withdrawal from the program as noted in the 2014-2015 PA Department Student
Handbook.
REGISTRATION: It is the responsibility of the student to register for all courses during the clinical
year. Failure to register by the final deadline will result in the loss of financial aid.
Students should download a copy of the Academic Calendar from the USA Homepage to note
registration dates. Students who fail to register should notify the Program Director as soon as
possible to that they can be referred to the Associate Dean to remedy this error. The student will be
responsible for all fees associated with late registration.
DISABILITIES: In accordance with the Americans with Disabilities Act, students with bona fide
disabilities will be afforded reasonable accommodations. The Office of Special Student Services
(OSSS) will certify a disability and advise faculty members of reasonable accommodations. If you
have a specific disability that qualifies you for academic accommodations, please notify the
instructor/professor and provide certification from the Office of Special Student Services. OSSS is
located at 5828 Old Shell Road at Jaguar Drive, (251-460-7212). NOTE: all requests for
accommodations for the clinical year must be documented through the OSSS and should be done
in a timely manner or accommodations will not be requested of the preceptor or rotation sit.
July 2015
134
PROFESSIONALISM
The highest standards of honesty and integrity are expected of University of South Alabama
physician assistant students. Any Student who cheats during the clinical year on end-ofrotation examinations, or any assignments required during the year, will be dismissed from
the Program. Failure to maintain a clinical patient log or turn in all required assignments and
documents to the Program Director will result in loss of points from the final rotation grade.
All clinical students in the Department of Physician Assistant Studies are held to highest
degree of professional standards.
Physician assistant students are expected to display altruism, accountability, excellence,
duty, honor, integrity, and respect for others. Unprofessional behavior is a poor reflection on
the student, the program and the Physician Assistant profession as a whole, and will not be
tolerated.
As physician assistant students and adult learners, it is your responsibility to take the
initiative for your education throughout every phase of the program. Your success will be
primarily dependent upon your own personal effort.
Any violations of appropriate academic or professional conduct will be referred to the
Student Progress Committee for review and possible dismissal from the program.
July 2015
135
II.
Professional Standards
e.
f.
July 2015
2.
b.
c.
3.
4.
5.
136
B.
6.
7.
C.
Attendance
1.
Students are given a specific time to report on their first day of each rotation
and are required to work until the end of the day, on the last Wednesday of
the rotation, unless otherwise directed by the PA Program or preceptor. After
the first day, the scheduled is determined by the preceptor and may include
call, days off, and research assignments. Students are expected to clarify all
schedule issues with the preceptor on the first day of the rotation.
2.
The first point of contact regarding approval for absences from the rotation is
the Director of Clinical Education (DCE). The initial contact should first occur
via telephone and followed by an email to the DCE. In the event the DCE is
unavailable, the student should contact the Program Director. Students
should not ASSUME he/she has approval to be absent from a clinical rotation
site without the explicit approval of the DCE and/or Program Director.
Ms. Edwards, the Clinical Assistant, will notify the appropriate preceptor
regarding the absenteeism, and to obtain the required secondary approval by
the preceptor. Any absences without prior and explicit approval from the DCE
and/or Program Director may result in a failing grade.
Program Director: dabercrombie@southalabama.edu
Clinical Assistant: nedwards@southalabama.edu
Ms. Edwards number: 251-460-7596
Department mail number: 251-445-9334
July 2015
3.
4.
Preceptors are also informed to call the program about any absences from
the rotation. Note: some rotations require a medical evaluation prior to
excusing an absence.
137
5.
6.
b.
c.
d.
e.
f.
7.
D.
Natural disasters: Follow the procedure of the clinical site and notify the
program if you will not attend clinic. If there are any questions, contact the
Program Director.
July 2015
E.
2.
On the first day of each rotation, students must phone or email the
Department of Physician Assistant Studies to provide phone numbers at
which they can be reached during their rotation (day and evening hours).
3.
Failure to report phone numbers by the third day of the rotation will result in
the loss of points on the Clinical Coordinators evaluation.
All clinical students are required to wear short USA PA Program white coats
and USA name badges while assigned to patient care areas. Liability
insurance for students is provided ONLY if the students ID badge is worn.
While not wearing your coat/ID badge always keep locked and out of sight.
Two white coats with the Physician Assistant Student patch attached must
be ordered from Mrs. Dot Kerr at the USA Bookstore, Health Sciences
section.
2.
The following dress requirements also apply to PA students during the clinical
year:
a.
b.
c.
d.
e.
For all USA rotations, students are required to purchase their own
scrubs. These scrubs must be purchased from the USA Bookstore
and must be burgundy/wine in color. On rotations at other
institutions, you may be allowed to wear their scrubs. Scrub clothing
is the property of the institution - removing scrub clothing for personal
3.
July 2015
The term patient care area is understood to mean any hospital, clinic or
private physician office to which PA students are assigned for clinical
rotations.
139
F.
G.
2.
Students are responsible for registering themselves during the clinical year.
You have been given instructions regarding which courses for which to
register. Students are also responsible for meeting all fee deadlines as
directed by the University. Failure to pay registration fees on time may result
in the cancellation of registration by the University and loss of financial aid.
Students who fail to register should notify the Program Director immediately.
Students are responsible for any late fees associated with failure to register
properly.
3.
All clinical students are responsible for registering during the clinical year. A
spreadsheet containing registration for the entire year has been emailed to
you and is also loaded on Sakai. Furthermore, registration information is
available on the USA website www.southalabama.edu by following the link to
PAWS. All necessary information regarding deadlines with respect to
registration, fee payment, graduation deadlines, etc. is available through this
website.
All rotations are scheduled by the Program Director. The schedule for core
rotations has already been determined. Once a rotation has been scheduled,
changes will not be permitted. The final decision in scheduling all rotations is
at the discretion of the faculty.
Decisions regarding Elective I rotations are due 3 months prior to the start of
the rotation. No changes will be made this deadline. Please see the Clinical
Rotation Schedule (page 8) for deadlines regarding Elective II.
H.
2.
The program reserves the right to change any clinical rotation for any reason,
at any time. Therefore, students should have a 12 month backup plan for
family and pet care needs. No personal commitments should be made
during the clinical year. It is advised to not give up local housing for out of
town rotations.
3.
All students are expected to perform rural rotations that are vested in
providing our students with quality, community based education.
4.
Housing
1.
July 2015
2.
I.
Leave of Absence
1.
2.
b.
3.
J.
K.
July 2015
All students are required to return to Mobile on the last Friday of each
rotation, and some Thursdays (see rotation specific syllabi), at the specified
time for the end-of-rotation examinations and seminars and remain until 3:00
p.m.
a.
b.
General Responsibilities
1.
2.
Students are reminded that use of illicit drugs is incompatible with the
professional role of the physician assistant. In addition to legal
consequences, students who use illicit drugs during the clinical year are at
141
risk for dismissal from the PA Program. Usage of either illicit drugs OR
alcoholic beverages while on clinical rotations will be referred to the Student
Progress Committee.
At any time during the clinical year, the Program Director can require a urine
drug screen from clinical students. Any student found to have a positive drug
screen (i.e. using drugs) will be suspended from the program until
rehabilitation treatment (approved by the State of Alabama, Alabama
Physician Health Program) is completed. If the student returns to the
program, they can be re-tested at the programs discretion. If a student has
tested positive in the past, a positive test will result in dismissal from the
program. (ref. Pat Capps Covey College of Allied Health Professions, Policy
and Procedures Manual, May 3, 2011).
The PA Program, including clinical preceptors and rotation sites, reserves the
right to demand random drug testing at any point during the clinical year.
3.
4.
Students are expected to conduct all personal business and social activities
after normal working hours. Cell phone calls, text messaging, Facebook,
Twitter, Tumblr, and non-medical Internet activity are NOT appropriate for
rotation hours. Such behavior is unprofessional and will result in loss of
points on the Clinical Coordinator Evaluation. Please refer to the Social
Media Policy for more details.
5.
Male students must obtain a female chaperone for female breast and pelvic
examinations, and female students must obtain chaperones for examinations
on males.
6.
7.
Sexual Harassment
a. In addition to being a violation of state and federal law, behavior involving
unwanted sexual advances, requests for sexual favors, or other verbal or
physical conduct of a sexual nature is incompatible with faculty, staff, and
student status at the University of South Alabama.
b. All PA students completed a mandatory sexual harassment session
during their didactic year. To review the Universitys policy on Sexual
Harassment, please refer to the Lowdown:
http://www.southalabama.edu/lowdown
c.
July 2015
8.
9.
References
a. Graduates must provide the program with written authorization
before any references/recommendations can be given.
L.
Immunizations
1.
2.
July 2015
143
3.
M.
Risk Management
1.
All students are required to have adequate health insurance coverage. The
adequacy of a given health insurance plan is NOT determined by the PA
program. United Healthcare is responsible for managing the plan offered to
USA medical and physician assistant students. For questions concerning
health insurance coverage, please contact Rhonda Baxter 460-6022.
The PA Program does not provide disability coverage in the event of an
accident while on clinical rotations. It is recommended that students
consider this additional coverage. The University does cover malpractice
liability for students on rotation, so long as the student is functioning within
the guidelines of this manual. The program does not assume any
responsibility if the student is injured while on or away from the clinical
rotation.
N.
July 2015
2.
3.
Social Media Policies: USA students are expected to adhere to the standards of
conduct listed below in the clinical setting. Laws and policies respecting conflict of
interest, as well as applicable policies and guidelines for interacting with patients,
preceptors, etc., apply online and in the social media context just as they do in
personal interactions. Students are fully responsible for what they post to social
media sites. Please read the following guidelines and policies and adhere to them
throughout the clinical year.
1.
Use good judgment about content and respect privacy laws. Do not include
confidential information about the University, its staff, or students.
2.
3.
4.
By posting content to any social media site, the poster represents that the
poster owns or otherwise has all of the rights necessary to lawfully use that
content or that the use of the content is permitted by fair use. Posters also
agree that they will not knowingly provide misleading or false information, and
they will indemnify and hold the University harmless for any claims resulting
from the content.
5.
Refrain from using information and conducting activities that may violate local,
state, or federal laws and regulations. If you are unsure whether certain
content is protected by privacy or intellectual property laws. Contact the
Program Director for clarification.
6.
Do not post information, photos or videos that will reflect negatively on you,
your clinical rotation site, your preceptor, your academic department, or USA.
7.
8.
9.
10.
11.
July 2015
12.
13.
14.
The USA PA Program also strictly prohibits text messaging between students
and patients. Texting is an abbreviated form of communication with a greatly
possibility of miscommunication but more importantly, patient confidentiality
will be compromised.
15.
Keep in mind that you should not disclose confidential information about any
clinical rotation site, its professionals or patients. It is also unprofessional to
discuss personal opinions about a clinical site and/or its patients and staff.
16.
17.
18.
19.
Safety Tips
Personal Safety:
1. Walk with a friend whenever possible.
2. When walking at night, stick to well-traveled, well-lit areas.
3. If you are being followed, walk to a populated area and call 911.
4. Walk with your head up being aware of your surroundings, making eye contact.
5. Have your car keys ready at all times.
6. Have your bags packed neatly before you leave the clinic so that you do not appear
disorganized and fumbling to get in your vehicle.
July 2015
146
July 2015
147
July 2015
148
According to the World Health Organization (WHO), PEP is short-term antiretroviral treatment to reduce
the likelihood of HIV infection after potential exposure.
Post-exposure Procedure:
Student/Employee:
1.
2.
3.
4.
5.
6.
Immediately wash needle stick injuries, cuts, or splashed area with copious amounts of soap
and water (first aid). Eyes should be rinsed with water/saline.
Report any potential exposure to your training supervisor immediately after administering
yourself first aid.
Mandatory requirements include student or employee blood work and initial exposure evaluation
by a PEP-trained provide, as is outlined below. Accepting PEP drug therapy is voluntary.
However, you are strongly encouraged to take PEP for an exposure to blood or body fluid from
a known HIV infected person as soon as it is offered.
Baseline student/employee laboratory work should include a complete blood count (CBC), renal
and hepatic function tests, pregnancy test (if appropriate), Hepatitis B surface antibody (IgG)
Hepatitis B core antibody (total), Hepatitis C antibody (total), and standard HIV by ELISA.
Report incident and action taken to your academic department as soon as possible.
Medical questions, or concerns (e.g. treatment delay) not fully addressed by training site
personnel can be discussed directly with on-call Infectious Disease (ID) physician
specialist at USA by calling 251-471-7895 (Monday through Friday, 8 a.m. - 5 p.m.). After hours,
call the USAMC operator at 251-471-7000. Identify yourself, your location, and phone number
that you can be immediately reached at by ID personnel.
Initiate appropriate on-site PEP procedure. Procedural specifications are usually found in
workplace Exposure Control Plan or Employee Health Plan. Currently recommended drugs for
PEP are Combivir one po BID, and Isentress 400mg one po BID. If there are questions at the
local site about the appropriateness of PEP for an exposure, or if the above regimen is not
available, please contact the USA ID physician specialist, as detailed above.
2.
Students performing practicums within two hours travel time to USAMC should report directly
Employee Health Monday through Friday between 7:30-am-3:30pm and to the ER after hours
and on weekends/holidays. If the student is more than two hours travel time from USAMC,
students should be referred to affiliated institutions Employee Health Nurse, Trauma Care
provider, or Infectious Disease specialist if practicum site is at a physician office or/clinic where
on-site PEP is not available. Antiretroviral drugs should be administered with 4 hours postexposure.
3.
The following tests should be drawn on the SOURCE PATIENT: Hepatitis B surface
antigen, Hepatitis B core IgM, Hepatitis C total antibody, and Rapid HIV. If positive, a
confirmatory HIV by ELISA with Western blot confirmation should be obtained.
4.
Coordination of PEP with on-call University of South Alabama (USA) Infectious Disease
July 2015
149
Working Hours
After Hours
(8:00 AM - 5:00 PM) (Nights/Weekends)
Cardiorespiratory Care
251-445-9284
Emergency Medical
Services Training
251- 461-1832
Occupational Therapy
251-445-9222
Physician Assistant
Studies
251-445-9338
Physical Therapy
251-445-9330
Radiological Sciences
251-445-9346
Dr. Newell 251-661-6629 *
Ms. Hudson 251-634-0165
251-445-9378
251-445-9297
July 2015
150
Appendix G:
Name:
(student, employee)
Incident date:
Incident location:
Printed Name:
Signature:
Date:
Handling: Attach a copy of retained incident report & send both items to College Biosafety Officer.
July 2015
151
Employee
Name:
Last
Student
Visitor
First
Middle
Home Address:
Date of Birth:
Social Security #:
Name of Supervisor:
Office Address:
DETAILS OF ACCIDENTIINCIDENT
Incident Date:
Time:
a.m.
p.m.
Location of Accident:
Name:
Phone:
Date:
Dme:' ___________________________ _
By signing above, I, the injuredlreporting party, understand that I have one year from the date of the accidentlincident for filing a claim with the State
Board of Adjustment and that any questions I have regarding the State Board should be directed to Human Resources (for employees) or the Office of
Risk Management. Was medical treatment received: eYeS
if yes, Date of treatment __________________________ _
Name and address of provider:
This document, when prepared and maintained by USA Hospitals, is done so in the QA activity of the University of South Alabama Hospitals, and is PRIVILEGED
AND CONFIDENTIAL pursuant to 22-21-8 and 34-24-58 of the 1975 Code of Alabama
DO NOT DUPLICATE
July 2015
152
Recommendations:
Date:
Signature
Administrative Review/Actions:
Recommendations:
Date:
Signature
Recommendations:
Date:
Signature
This document, when prepared and maintained by USA Hospitals, is done so in the QA activity of the University of South Alabama Hospitals, and is PRIVILEGED
AND CONFIDENTIAL pursuant to 22-21-8 and 34-24-58 of the 1975 Code of Alabama
July 2015
153
B.
Instructional
1.
Provide clinical instruction and supervision for the student. Direct supervision
means the clinical preceptor (this may include residents when the rotation
occurs in a teaching institution) will directly observe all invasive procedures
performed by students.
2.
3.
4.
5.
Provide the student with ongoing constructive critique relative to the clinical
performance.
6.
Administrative
1.
Assign student to appropriate clinical area, i.e. ward, clinic, office, and/or
emergency room.
2.
Familiarize the student with personnel and day-to-day routine of the facility.
3.
4.
If deemed necessary, meet with student and PA Program Director during the
rotation to discuss:
a. Written evaluation form (mid-rotation evaluation form)
b. Clinical and interpersonal strengths and weaknesses
C.
5.
6.
PA Student Expectations
1.
Students are expected to notify the program in the event of any changes in their
personal contact information (e.g., address, telephone, cell phone).
2.
Students are expected to maintain their USA jagmail e-mail addresses. The program
will only acknowledge the student's assigned university email address.
154
July 2015
3.
Students are expected to adhere to the logistics of the clinical site and rotation, (e.g.,
instructions for basic office systems, resources available for the learner,
characteristics of clinical site and population served, role of other staff and
healthcare providers), as stipulated by the preceptor on day one of the clinical
rotation.
4.
Students are expected to be on time for clinical shifts. Contact your supervising
physician(s) or his or her PA designee, AND, the Program Director, if you anticipate
any scheduling conflicts or if you have questions regarding your schedule.
5.
6.
Students are expected to present clinical findings to the preceptor in proper case
presentation format.
7.
Students are accountable for all materials in the rotation objectives, to include
assigned readings, regardless of whether the materials are explicitly covered by the
clinical preceptor.
8.
Students are expected to work the shift schedule developed by the supervising
physician(s).
9.
10.
Students are expected to ask for help early on if needed, and notify the supervising
physician(s) or his or her PA designee immediately if your patient encounter involves a
patient with abnormal vital signs, shortness of breath, chest pain, and abdominal
pain with peritoneal findings or changes in mental status.
11.
Students are expected to ask the supervising physician for feedback regarding
his/her progress mid-way through the rotation.
12.
13.
14.
15.
Students are expected to complete all patient-related duties before the completion of
your shift.
16.
Students are expected to inform the supervising physician(s) or his or her PA designee
before you leave the rotation at the conclusion of your shift. This will help to ensure all
patient-related matters have been addressed.
July 2015
155
July 2015
156
July 2015
157
Family History
The family history must include the age, sex, emotional status, and health of other members of the
family. Other useful information includes chronological data on pregnancies, deaths and
miscarriages, history of allergy, cancer, inborn errors of metabolism, convulsions, rheumatic heart
disease, premature coronary artery disease (myocardial infarction under the age of 50 years),
hypertension (these two items institute preventative measures), tuberculosis, venereal and
neurological diseases.
Review of Systems
CNS: Headache, tinnitus, vision, convulsion (description, duration, frequency, post-ictal state),
weakness, ataxia, parathesias.
Musculoskeletal: Weakness, muscle or bone pain, wasting.
Skin and R-E System: Rash (color, consistency, distribution) pruritis, jaundice, easy bruisability,
cyanosis, lymph nodes, enlarging mass.
Respiratory: Cough, sputum, wheeze, hemoptysis, chest pain, dyspnea, ear ache, coryza.
Cardiovascular: Heart murmur, easy fatigability, cyanosis, squatting, dyspnea on exertion, chest
pain.
Gastrointestinal: Feeding problems, regurgitation, vomiting, abdominal pain, stools, melana, gross
blood, encopresis.
G.U.: Enuresis, dysuria, frequency, urgency, stream, hematuria, discharge.
Allergies: Drugs, allergens.
Physical Examination
The physical examination is a permanent record of what is found plus a record of what is not found.
Therefore, pertinent negative findings should be recorded.
Remember that each child must be approached differently. The principal thing is not to do anything
that will frighten the child. Some children will respond better when they are allowed to sit and listen
while you examine the chest initially. Other children will be frightened by the stethoscope and will do
better if the abdomen is examined first. The head and neck examination is the last thing done
after one examines the mouth and throat all rapport is gone!
Always respect a childs modesty. Children at the age of 5 and 8 are sometimes the most modest
people you will ever encounter.
General
Observe the childs behavior, body build, appearance of acute and chronic illness and state of
nutrition and development. Record the height and weight. Place the percentile for height and weight
in parenthesis after these measurements.
Measurement of head size is a routine part of a pediatric examination. The skull is subject to many
variations in shape, particularly in the newborn infant. Molding, the width of the sutures and the
patency of the fontanels all contribute to shaping. The anterior fontanelle should be palpated for the
degree of tension. Cephalhematoma, meningocele, and encephalocele are immediate findings in
the newborn period.
July 2015
158
The facies may be characteristic in many diseases such as Downs Syndrome, Hurlers Syndrome,
etc. The symmetry of the face and smile are neurological clues. Mouth breathing may indicate nasal
obstruction. Flaring of the ala nasae is seen in respiratory diseases.
Eyes
Frequently epicanthal folds are present in infancy and may give the illusion of extraocular muscle
imbalance. With a distant light source, the fact that the reflection falls in the same spot on both
pupils can refute this. Skill in ophthalmoscopic examination should be practiced on every child and
the appearance of the sclerae and conjunctivae should be documented.
Ears
Note the set of the ears a low position below the eyes and with a forward sweep is part of
syndromes involving brain defect or congenital kidney disturbance. Is there a brachial cleft cyst?
Does the child hear? Note the appearance of the ear canals and tympanic membranes.
Nose
A foreign body, long present in the nose, will cause a unilateral discharge with an odor. The most
common place to look for a source of nosebleeds is Kiesselbacks triangle. The sinuses should be
lightly tapped and pressured for signs of tenderness. This may be explored further by
transilllumination and by inspection of the turbinates for swelling.
Lips
Check for weakness and ability to suck. Is there pallor, cyanosis or cherry-red color? Check for
harelip, herpes, chapping, fissures, rhagades, scars and cheilosis.
Mouth
Note breath odor, the shape and possible distortions or defects of the hard and soft palate,
movement of the soft palate, condition and color of the buccal mucosa, status of the teeth, gums
and Stinsons duct orifice and contour of the jaw.
Neck
Note muscle strength, lymph nodes, parotid gland or thyroid. Is the neck supple?
Chest
Examination of the rib cage, shape, increased A-P diameter, sternum, bulges, intercostals or
supraclavicular retractions should be noted. Excursions of the chest should be carefully observed for
deviation from one side or the other. Palpation for crepitus should always be carried out.
Lungs
The quality of breath sounds vary with the age of the child and thickness of the chest wall. In
children with small, thin chest walls, bronchial breath sounds are normal. In older children, vesicular
breath sounds become normal. The presence of unequal breath sounds, rales, rhonchi or
transmitted sounds should be noted. Rales should be characterized as fine or coarse and wheezes
as expiratory or inspiratory and low or high pitched. Record findings on percussion.
Heart
The brachial and femoral pulses should be palpated simultaneously and recorded as to equality and
amplitude. The precordium should be palpated and note made as to the activity of right and left
ventricle (hypo, normal or hyper). Thrills should be noted as to location, intensity and timing.
Auscultation with bell and diaphragm should be performed and the intensity of the 1st and 2nd sound
recorded. The presence of splitting of the 2nd sound at the pulmonic area and its relationship to
respiration should be noted. The presence of 3rd and 4th heart sounds and clicks should be noted.
The frequency, location of maximum intensity and radiation should be recorded. Blood pressure
should be taken with the proper cuff size. The cuff should cover 2/3 of the upper arm.
July 2015
159
Abdomen
The appearance of the abdomen should be noted as whether flat, distended, areas of swelling, etc.
Light palpation is carried out for muscle guarding or extreme tenderness. Gentle palpation will
usually detect an enlarged liver or spleen better than more vigorous palpation. Always begin to
palpate for both at the iliac crest. The distance below the rib cage, configuration, consistency, and
presence of any tenderness should be documented as to size, exact location, consistency,
tenderness, shape and character of the bowel sounds should be noted along with any visible
peristalsis. Umbilical hernias showed noted as to size of the defect.
The size, tenderness, whether matted or singularly enlarged, character of overlying skin and the
chain of lymph nodes involved should be carefully noted.
Genitalia
In the male, the position and the size of the urethral meatus should be noted. Palpation of the testes
is important in the detection of an atrophic or undescended testicle. Transillumination and
observation will reveal the presence of a hydrocele. The inguinal ring should always be palpated and
the degree of tightness noted.
In the female, the presence of clitoral hypertrophy, adhesions, or discharge should be noted. In the
neonate, there is a hymenal hypertrophy and there may be some vaginal bleeding for a few days.
Simple labial adhesions are not abnormal or uncommon and separation can be easily accomplished.
The newborn male or female may have lactating breasts. Adolescent boys may have some temporary
breast development behind the nipple which is tender and may be unilateral or bilateral. Girls may
have unilateral breast development initially.
Extremities
Check toes and fingers for clubbing, cyanosis or pallor. Are the nails disfigured or friable? Are the
interphalangeal spaces cracked or eroded?
In a child with fever, carefully check the bones for tenderness. Watch for inflamed joints and
maintaining a fixed position or splinting a joint. Remember knee pain in a child is usually referred
from the hip.
Rectal
Rectal examination should not be avoided. It is very helpful for examination of pelvic structures or
masses. In a newborn be sure that the rectum is patent and a fistula is not present allowing
passages of meconium.
Neurological
This can be done in a large degree by observing the child. Careful evaluation of muscle strength,
coordination and development should be made. Cerebellar function tests should be carefully carried
out for this is the most frequent site of brain tumors in children. The presence of nystagmus, cranial
function, etc., can usually be done better by observation rather than formal testing. Record the
briskness and quality of the deep tendon reflexes. Observe the gait of every child who can walk while
barefooted. Mental condition should be described as to apparent intelligence restlessness, speech
defect, apathy, coma, stupor, delirium, convulsions, torpor or obtunded.
In newborn infants check for moro, rooting, tonic neck and sucking reflexes.
July 2015
160
Meds in margin
S:
Pt complaints, contractions CTX?, vaginal bleeding VB?, HA? Dysuria?
N/V/D? Constipation?
O:
VS: Temp, BP, Pulse, RR, (afebrile vital signs stableAFVSS)
STERILE VAGINAL EXAM: dil/efface/stage; intact, ROM, AROM
TOCO/IUPC: ctx freq, duration, reg/irreg (study last 20 mins of strip)
FHR: rate, reactivity, variability, accels, decels (study last 20 mins of strip)
PE :
Gen: alert, oriented, mood, NAD
CV: RRR , brisk cap refill, distal pulses 2+ bilat (check DP & PT)
Pulm: CTAB
Abd: gravid, +BS x 4 quad, fundal tenderness FT
Ext: edema, tender, check DTR if on mag
LABS: bloodtype, rubella, VDRL (syphilis), HBsAg, HIV, GBS, GC/Chl
A: ____yo __F G__P f_p_a_l_ with intrauterine pregnancy IUP
@ ____wk EGA by LMP/consistent w/ sono and
PROM, PPROM, PreE, twins, GBS +
Diabetes A (gestational), A1 (gestational, controlled by diet), A2
(gestational, controlled by meds), B (dx>age 20 or had < 2yrs),C (age
of onset 10-19 or had 10-19 yrs, D (age of onset 0-9 yrs or had >20
years), H (cardiac involvement), F (renal involvement), R (retinal
involvement)
In active/ latent labor- reactive strip
P:
continue current management
anticipate spontaneous vaginal delivery SVD
start pit for labor augmentation (2 milliunits/min> bolus?)
if preterm labor-MgSO4/indomethacin/ nifedipine(Procardia) for
tocolysis. Note: indomethacin may close ductus arteriosis as opposed
to prostaglandin E2
misoprostil (cytotec)for fetal demise IUFD
betamethazine BMZ if preterm labor for lung maturation
PCN G if GPS +
LR at 125 cc per hr
Nubain 5mg for pain, epidural at 4cm?
Activity: Bedrest, bathroom privileges
Diet: NPO, ice chips
Labs: Mag level
July 2015
161
S:
breast or bottle?__________
birth control form of choice (only Depo if breast-feeding and no patch if
>190lbs)___________________________________
Lochia (as compared with menstruation)?____________
Vitals :____________________________________________________________
Exam:
Labs
O:
July 2015
162
Vitals :____________________________________________________________
Ins/Outs:__________________________________________________________
Exam:
Labs
O:
A:
P:
July 2015
163
July 2015
164
Sample OP Note
Preop Dx: Acute Cholecystitis
Postop Dx: Same
Procedures: Laparoscopic Cholecystectomy
Surgeons: Attending: Gandy, Resident: Smith, Student Parker
Findings: Acutely inflamed gallbladder
Anesthesia: GETA
Fluids: 200 cc LR*
EBL: 15cc*
Drains: JP Drain in RUQ
Specimen: Gallbladder and cystic duct
Complications: none
Condition: Patient extubated and transferred to recovery room in stable condition
*ask anesthesia for these numbers
Sample Progress Note
08/26/10
July 2015
165
Preamble
In 2003, the National Commission on Certification of Physician Assistants (NCCPA) initiated
an effort to define PA competencies in response to similar efforts being conducted within
other health care professions and growing demand for accountability and assessment in
clinical practice. The following year, representatives from three other national PA
organizations, each bringing a unique perspective and valuable insights, joined NCCPA in
that effort. Those organizations were the Accreditation Review Commission for Education of
the Physician Assistant (ARC-P A), the body that accredits PA educational programs; the
Association of Physician Assistant Programs (APAP), the membership association for PA
educators and program directors; and the American Academy of Physician Assistants (AAP
A), the only national membership association representing all PAs.
The resultant document, Competencies for the Physician Assistant Profession, is a
foundation from which each of those four organizations, other physician assistant
organizations and individual physician assistants themselves can chart a course for
advancing the competencies of the P A profession.
Introduction
The purpose of this document is to communicate to the PA profession and the public a set
of competencies that all physician assistants regardless of specialty or setting are
expected to acquire and maintain throughout their careers. This document serves as a
map for the individual PA, the physician-PA team and organizations that are committed to
promoting the development and maintenance of these professional competencies among
physician assistants.
The clinical role of PAs includes primary and specialty care in medical and surgical practice
settings. Professional competencies! for physician assistants include the effective and
appropriate application of medical knowledge, interpersonal and communication skills,
patient care, professionalism, practice-based learning and improvement, systems-based
practice, as well as an unwavering commitment to continual learning, professional growth
and the physician-P A team, for the benefit of patients and the larger community being
served. These competencies are demonstrated within the scope of practice, whether
medical or surgical, for each individual physician assistant as that scope is defined by the
supervising physician and appropriate to the practice setting.
I In 1999, the Accreditation Council for Graduation Medical Education (ACGME) endorsed a list of general competencies
for medical residents. NCCP A's Eligibility Committee, with substantial input from representatives of AAPA, APAP and ARCPA, has modified the ACGME's list for physician assistant practice, drawing from several other resources, including the
work of Drs. Epstein and Hundert; research conducted by AAPA's EVP/CEO, Dr.
Steve Crane; and NCCP A's own examination content blueprint.
July 2015
166
July 2015
167
create and sustain a therapeutic and ethically sound relationship with patients
use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit
and provide information
appropriately adapt communication style and messages to the context of the
individual patient interaction
work effectively with physicians and other health care professionals as a member
or leader of a health care team or other professional group
apply an understanding of human behavior
demonstrate emotional resilience and stability, adaptability, flexibility and tolerance
of ambiguity and anxiety
accurately and adequately document and record information regarding the care
process for medical, legal, quality and financial purposes
PATIENT CARE
Patient care includes age-appropriate assessment, evaluation and management. Physician
assistants must demonstrate care that is effective, patient-centered, timely, efficient and
equitable for the treatment of health problems and the promotion of wellness. Physician
assistants are expected to:
work effectively with physicians and other health care professionals to provide
patient- centered care
demonstrate caring and respectful behaviors when interacting with patients and
their families
gather essential and accurate information about their patients
make informed decisions about diagnostic and therapeutic interventions based on
patient information and preferences, up-to-date scientific evidence, and clinical
judgment
develop and carry out patient management plans
counsel and educate patients and their families
competently perform medical and surgical procedures considered essential in the area
of practice
provide health care services and education aimed at preventing health problems
or maintaining health
July 2015
168
PROFESSIONALISM
Professionalism is the expression of positive values and ideals as care is delivered.
Foremost, it involves prioritizing the interests of those being served above one's own.
Physician assistants must know their professional and personal limitations. Professionalism
also requires that PAs practice without impairment from substance abuse, cognitive
deficiency or mental illness. Physician assistants must demonstrate a high level of
responsibility, ethical practice, sensitivity to a diverse patient population and adherence to
legal and regulatory requirements. Physician assistants are expected to demonstrate:
July 2015
169
SYSTEMS-BASED PRACTICE
Systems-based practice encompasses the societal, organizational and economic
environments in which health care is delivered. Physician assist ants must demonstrate an
awareness of and responsiveness to the larger system of health care to provide patient care
that is of optimal value. P As should work to improve the larger health care system of which
their practices are a part.
Physician assistants are expected to:
use information technology to support patient care decisions and patient education
effectively interact with different types of medical practice and delivery systems
understand the funding sources and payment systems that provide coverage for
patient care
practice cost-effective health care and resource allocation that does not
compromise quality of care
advocate for quality patient care and assist patients in dealing with system
complexities
partner with supervising physicians, health care managers and other health care
providers to assess, coordinate, and improve the delivery of health care and patient
outcomes
accept responsibility for promoting a safe environment for patient care and
recognizing and correcting systems-based factors that negatively impact patient care
apply medical information and clinical data systems to provide more effective,
efficient patient care
use the systems responsible for the appropriate payment of services
July 2015
170
%of
%of
Content
Content
16%
16%
Cardiovascular System
5%
Dermatologic System
14%
9%
18%
6%
Endocrine System
10%
Health Maintenance
10%
Gastrointestinal - Nutrition
14%
Clinical Intervention
6%
Genitourinary System
18%
Pharmaceutical Therapeutics
3%
Hematologic System
10%
3%
Infectious Diseases
10%
Musculoskeletal System
6%
Neurologic System
6%
Psychiatry/Behavioral
12%
Pulmonary
8%
Reproductive System
On the following pages, we have provided lists of specific diseases, disorders, medical assessments, and
knowledge areas you may encounter on your exam. Though these lists are not exhaustive, they can provide a
foundation for your exam preparation. They serve as your blueprint to the exam content.
July 2015
171
Dilated
Hypertrophic
Restrictive
Conduction Disorders
Atrial fibrillation/flutter
Atrioventricular block
Premature beats
Ventricular tachycardia
Ventricular fibrillation
Torsades de pointes
Congenital Heart Disease
Coarctation of aorta
Tetralogy ofFaIlot
Essential
Secondary
Hypertensive emergencies
Hypotension
Cardiogenic shock
Orthostatic hypotension
Coronary Heart Disease
ST segment
Angina pectoris
Stable
Unstable
Prinzmetal variant
Vascular Disease
Aortic aneurysm/dissection
Arterial embolism/thrombosis
Phlebitis/thrombophlebitis
Varicose veins
Venous insufficiency
Venous thrombosis
July 2015
172
Valvular Disease
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Tricuspid stenosis
Tricuspid regurgitation
Pulmonary stenosis
Pulmonary regurgitation
Other Forms of Heart Disease
Acute pericarditis
Cardiac tamponade
Pericardial effusion
Dermatitis
Dyshidrosis
Drug eruptions
Lichen planus
Pityriasis rosea
Psoriasis
Desquamation
Erythema multiforme
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Vesicular Bullae
Bullous pemphigoid
Acneiform Lesions
Acne vulgaris
Rosacea
Verrucous Lesions
Actinic keratosis
Seborrheic keratosis
InsectslParasites
Lice
Scabies
Neoplasms
July 2015
173
Viral Diseases
Condyloma acuminatum
Exanthems
Herpes simplex
Molluscum contagiosum
Varicella-zoster virus infections
Verrucae
Bacterial Infections
Cellulitis
Erysipelas
Impetigo
Fungal Infections
Candidiasis
Dermatophyte infections
Other
Acanthosis nigricans
Bums
Hidradenitis suppurativa
Lipomas/epithelial inclusion cysts
Melasma
Pilonidal disease
Pressure ulcers
Urticaria
Vitiligo
Blepharitis
Blowout fracture
Cataract
Chalazion
Conjunctivitis
Corneal abrasion
Corneal ulcer
Dacryocystitis
Ectropion
Entropion
Foreign body
Glaucoma
Hordeolum
Hyphema
Macular degeneration
Nystagmus
Optic neuritis
Orbital cellulitis
Papilledema
Pterygium
Retinal detachment
Retinal vascular occlusion
Retinopathy
Strabismus
Ear Disorders
July 2015
174
Acoustic neuroma
Barotrauma
Cholesteatoma
Dysfunction of eustachian tube
Foreign body
Hearing impairment
Hematoma of external ear
Labyrinthitis
Mastoiditis
Meniere disease
Otitis extern a
Tinnitus
Tympanic membrane perforation
Vertigo
Nose/Sinus Disorders
Acute/chronic sinusitis
Allergic rhinitis
Epistaxis
Foreign body
Nasal polyps
Mouth/Throat Disorders
Acute pharyngitis
Aphthous ulcers
Epiglottitis
Laryngitis
Oral candidiasis
Oral leukoplakia
Peritonsillar abscess
Parotitis
Sialadenitis
Benign and malignant neoplasms
Esophagitis
Motility disorders
Mallory-Weiss tear
Neoplasms
Strictures
Varices
Stomach
Gallbladder
Acute/chronic cholecystitis
Cholangitis
Cholelithiasis
July 2015
175
Liver
Acute/chronic hepatitis
Cirrhosis
Neoplasms
Pancreas
Acute/chronic pancreatitis
Neoplasms
Small Intestine/Colon
Appendicitis
Celiac disease
Constipation
Diverticular disease
Intussusception
Lactose intolerance
Neoplasms
Obstruction
Polyps
Toxic megacolon
Rectum
Anal fissure
Abscess/fistula
Fecal impaction
Hemorrhoids
Neoplasm
Hernia
Infectious and Non-infections Diarrhea
Vitamin and Nutritional Deficiencies
Metabolic Disorders
Phenylketonuria
Congenital abnormalities
Cryptorchidism
Erectile dysfunction
Hydrocele/varicocele
Incontinence
Nephro/urolithiasis
Paraphimosis/phimosis
Testicular torsion
Infectious/Inflammatory Conditions
Cystitis
Epididymitis
Orchitis
Prostatitis
Pyelonephritis
July 2015
176
Urethritis
Neoplastic Diseases
Bladder carcinoma
Prostate carcinoma
Testicular carcinoma
Wilms tumor
Renal Diseases
Glomerulonephritis
Hydronephrosis
Nephrotic syndrome
Hypervolemia
Hypovolemia
Acid/Base Disorders
Aplastic anemia
G6PD deficiency
Hemolytic anemia
Iron deficiency
Sickle cell anemia
Thalassemia
Vitamin B12 deficiency
Coagulation Disorders
Hypercoagulable states
Thrombocytopenia
Lymphoma
Multiple myeloma
Infectious Diseases
Fungal Disease
Candidiasis
Cryptococcosis
Histoplasmosis
Pneumocystis
Bacterial Disease
Botulism
July 2015
177
Chlamydia
Cholera
Diphtheria
Gonococcal infections
Salmonellosis
Shigellosis
Tetanus
Mycobacterial Disease
Tuberculosis
Parasitic Disease
Helminth infestations
Malaria
Pinworms
Toxoplasmosis
Spirochetal Disease
Lyme disease
Syphilis
Viral Disease
Cytomegalovirus infections
Erythema infectiosum
Herpes simplex
HIV infection
Influenza
Measles
Mumps
Rabies
Roseola
Rubella
Fractures/dislocations
Fractures/dislocations
Ankylosing spondylitis
Back strain/sprain
Cauda equina
Kyphosis
Scoliosis
Spinal stenosis
Disorders of the Hip
Avascular necrosis
Developmental dysplasia
July 2015
178
Fractures/dislocations
Slipped capital femoral epiphysis
Fractures/dislocations
Osgood-Schlatter disease
Fractures/dislocations
Acute/chronic osteomyelitis
Septic arthritis
Neoplastic Disease
Bone cysts/tumors
Ganglion cysts
Osteoarthritis
Osteoporosis
Compartment Syndrome
Rheumatologic Conditions
Fibromyalgia
Goutlpseudogout
Polyarteritis nodosa
Polymyositis
Polymyalgia rheumatica
Rheumatoid arthritis
Sjogren syndrome
Peripheral neuropathies
Headaches
Cluster headache
Migraine
Tension headache
Infectious Disorders
Encephalitis
Meningitis
Movement Disorders
Essential tremor
Huntington disease
Parkinson disease
Vascular Disorders
July 2015
179
Cerebral aneurysm
Intracranial hemorrhage
Stroke
Transient ischemic attack
Cerebral palsy
Concussion
Dementias
Delirium
Guillain-Barre syndrome
Multiple sclerosis
Myasthenia gravis
Post-concussion syndrome
Seizure disorders
Status epilepticus
Syncope
Tourette disorder
Psychiatry/Behavioral Science
Anxiety Disorders
Panic disorder
Phobias
Anorexia nervosa
Bulimia nervosa
Obesity
Mood Disorders
Adjustment
Bipolar
Depressive
Dysthymic
Personality Disorders
Psychoses
Delusional disorder
Schizophrenia
Somatoform Disorders
Substance Use Disorders
Abuse
Dependence
Withdrawal
Other Behavior/Emotional Disorders
Child/elder abuse
Conduct disorders
Domestic violence
July 2015
180
Grief reaction
Suicide
Acute bronchitis
Acute bronchiolitis
Acute epiglottitis
Croup
Influenza
Pertussis
Pneumonias
Bacterial
Viral
Fungal
HIV-related
Tuberculosis
Neoplastic Disease
Carcinoid tumors
Lung cancer
Pulmonary nodules
Obstructive Pulmonary Disease
Asthma
Bronchiectasis
Chronic bronchitis
Cystic fibrosis
Pleural Diseases
Pleural effusion
Pneumothorax
Pulmonary Circulation
Cor pulmonale
Pulmonary embolism
Pulmonary hypertension
Restrictive Pulmonary Disease
Pneumoconiosis
Sarcoidosis
Other Pulmonary Disease
July 2015
181
Prolapse
Ovary
Cysts
Neoplasms
Cervix
Carcinoma
Cervicitis
Dysplasia
Incompetent
VaginaNulva
Cystocele
Neoplasm
Prolapse
Rectocele
Vaginitis
Menstrual Disorders
Amenorrhea
Dysmenorrhea
Premenstrual syndrome
Menopause
Breast
Abscess
Carcinoma
Fibroadenoma
Fibrocystic disease
Gynecomastia
Galactorrhea
Mastitis
Normal labor/delivery
Prenatal diagnosis/care
Complicated Pregnancy
Abortion
Abruptio placentae
Cesarean section
Dystocia
Ectopic pregnancy
Fetal distress
Gestational diabetes
Multiple gestation
Placenta previa
Postpartum hemorrhage
Premature
rupture of membranes
Rh
incompatibilit
July 2015
182
The lists of knowledge areas and skills that follow were identified as important to physician assistant practice
through an intensive practice analysis. Many of these knowledge areas and associated cognitive skills are
covered on NCCPA's examinations.
July 2015
183
Pharmaceutical Therapeutics
Knowledge of:
Mechanism of action
Indications for use
Contraindications
Side effects
Adverse reactions
Follow-up and monitoring of
pharmacologic regimens
Risks for drug interactions
Clinical presentation of drug
interactions
Treatment of drug interactions
Drug toxicity
Methods to reduce medication errors
Cross reactivity of similar medications
Recognition and treatment of allergic
reactions
Health Maintenance
Knowledge of:
July 2015
184
NCCPA's exam questions are developed by committees comprising PAs and physicians selected based on both
their item writing skills, experience and references as well as demographic characteristics (i.e., practice specialty,
geographic
region, practice setting, etc.). The test committee members each independently write a certain number of test
questions or items, referencing each to a recently published textbook (not journal articles). Each item then goes
through an intense review by content experts and medial editors from which only some items emerge for pretesting. Every NCCPA exam includes both scored and pre- test items, and examinees have no way of
distinguishing between the two. This allows
NCCP A to collect important statistics about how the pre-test items perform on the exam, which informs the final
decision about whether a particular question meets the standards for inclusion as a scored item on future PANCE
or PANRE exams.
Pathway II exams are developed in much the same way as PANCE and PANRE exams. However, Pathway II
questions are not pre-tested due to the nature of that exam. Rather, after a preliminary analysis of each Pathway
II administration's results, statistical analyses are used to identify items that appear to have been problematic or
even flawed. Through this validation process, content experts review those items to determine whether the
answers had been keyed incorrectly in the scoring system or whether the item itself was flawed in some way.
Also, from time to time Pathway II examinees will contact NCCP A with questions or concerns about particular
exam items, which are also reviewed during the validation process. When the content experts identify a flawed
item, it is removed from the group of scored items and is not included in the scoring process.
When NCCPA exams are scored, candidates are initially awarded 1 point for every correct answer and 0 points for
incorrect answers to produce a raw score. After examinees' raw scores have been computed by two independent
computer systems to ensure accuracy, the scored response records for PANCE and PANRE examinees are
entered into a maximum likelihood estimation procedure, a sophisticated, mathematically-based procedure that
uses the difficulties of all the scored items in the form taken by an individual examinee as well as the number of
correct responses to calculate that examinee's proficiency measure. This calculation is based on the Rasch
model and equates the scores, compensating for minor differences in difficulty across different versions of the
exam. Thus, in the end, all proficiency measures are calculated as if everyone took the same exam. (That step is
not necessary for Pathway II since all examinees in a given administration take the same exam.)
Finally, the proficiency measure is converted to a scaled score so that results can be compared over time and
among different groups of examinees. The scale is based on the performance of a reference group (some
particular group of examinees who took the exam in the past) whose scores were scaled so that the average
proficiency measure was assigned a scaled score of 500 and the standard deviation was established at lOO. The
vast majority of scores fall between 200 and 800. More details on the reference group for each exam and the
calculation of scores will be provided in the form of Performance Interpretation Guidelines published with your
exam results.
Example Question
The questions on NCCPA exams are presented in multiple-choice format and most offer four or five answer
choices. An increasing percentage of exam questions are based on information presented in a clinical vignette,
which requires higher level thinking than some other common question formats.
A 58-year-old man who has a history of alcohol abuse complains of severe epigastric pain. He feels some relief
from the pain when he leans forward. In the past 24 hours he has experienced nausea and vomiting. He appears
acutely ill and restless. On physical examination, the patient is hypotensive and has a rapid pulse rate. Bowel
sounds are hypoactive, and there is abdominal tenderness with muscular rigidity and distention. The diagnosis
would be supported best by which of the following laboratory tests?
(A) Determination of the serum amylase level
(B) Electrocardiography
(C) Examination of the stool for ova and parasites
(D) Routine urinalysis
(E) Upper gastrointestinal series
July 2015
185
Student Signature
Date
July 2015
186
2.
I have read and fully understand each and every policy and procedure
outlined within this manual, and I agree to adhere to these policies
and procedures completely.
3.
4.
5.
6.
_______________________________
Student Name (PRINTED)
_______________________________
Student Signature and Date
_______________________________
Witness Signature and Date
July 2015
187
I
give written consent to the University of
South Alabama Department of Physician Assistant Studies to maintain and
release personal information including: name, address, email address,
telephone number, date of birth, social security number, immunization history,
tuberculosis screening and related chest x-ray results, background checks,
urine drug screen and information related to rotation grades, as requested by
clinical preceptors and clinical affiliates.
Signature
Witness
July 2015
188